What Is Heart Disease ?
Surely everyone knows that ! Uncle so and so died from it and Aunty whats her name ended up with paralysis and what about the child you knew down the road who was born with a heart defect !
But have you ever really studied it in a simplified way – I have set out this document to help you understand the different types of heart disease and what happens to the body.
Hopefully anyone reading any of my books will never suffer from any of these awful, life threatening diseases – unlike the 126,000 people who are dying each year from heart disease. (Stats from the British Heart Foundation)
What does the heart do
The heart pumps blood around the body through arteries and veins carrying oxygen and other nutrients to the areas that need it and waste out. When this process is interrupted, or does not work properly, serious illness and even death can result.
The risk of heart disease is greater for people with poor diet, who smoke and do not exercise, men are more likely to suffer from it than women.
The Heart pumps 100,000 times a day 2.5b times in the average lifetime and moves 2,000 gallons of blood every 24 hours
Heart Conditions
Heart Attack
A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle.
This is usually caused by atherosclerosis (hardening of the artery walls). The clot, often caused by rupturing or tearing of plaque in an artery is sometimes called a coronary thrombosis or a coronary occlusion.
If blood supply is cut off for a long time, muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage to the muscle.
A heart attack, also known as myocardial infarction, can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
An unexpected and abrupt heart attack occuring soon after the onset of symptoms can result in sudden death.
What Are The Main Symptoms
- Pressure or pain in the centre of the chest, lasting more than a few minutes or going away and coming back
- Pain spreading to the shoulders, neck or arms, particularly the left side
- Chest discomfort combined with light-headedness, fainting, sweating, nausea or shortness of breath
Other common warning signs of heart attack include unusual chest, stomach or abdominal pain, nausea or dizziness, shortness of breath or difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness.
Diagnosis of a heart attack usually involves a clinical examination, an electrocardiogram, heart rhythm monitoring and blood tests. Echocardiograms or angiograms will detect the extent of damage to the heart.
Heart failure
Does not mean the heart stops, it is simply not pumping blood as it should so the body does not get as much blood and oxygen as it needs.
It is caused by blocked arteries, past heart attack which has done some damage to the heart muscle or heart defects present since birth. High blood pressure, heart valve or heart muscle disease and infection of the heart or valves are also causes.
Blood backs up in the veins, causing a build up which leads to swelling in the feet, ankles and legs, called edema. Too much fluid can also build up in the lungs causing pulmonary congestion.
The result is shortness of breath, especially when lying down, a feeling of being tired and run-down, swelling in the feet, ankles and legs, weight gain from fluid build up and confusion or an inability to think clearly.
Basically, heart failure is when the heart “fails” to be able to do its job properly
Swelling of the ankles is due the kidneys receiving less blood than they should, leading them to consider there is insufficient blood in the bloodstream and to store sodium and salt, leading to swelling.
The main cause of heart failure is coronary disease damaging the heart muscle. Narrowed arteries restrict blood flow, making the heart beat faster, or a heart attack may damage the heart, preventing it functioning properly.
The quality of life for sufferers is poor and decreases over time – from difficulty exercising at first to problems with simple tasks such as dressing later. The long-term prognosis for people with heart failure is bad – similar to that of breast and lung cancer patients.
Angina
A feeling of pain, heaviness, tightness, burning or squeezing in the chest – is an indication that the sufferer has heart disease and is at risk of a heart attack.
Angina occurs when arteriosclerosis has caused so much narrowing of the coronary arteries that they are not able to supply enough blood to the heart muscle during exercise.
The pain can spread to the arms, neck, jaw, face back or stomach. In some people it is a dull, persistent ache.
Dr Tony Gershlick, consultant cardiologist and honorary senior lecturer at University Hospitals Leicester, said: “Angina is very debilitating and can effect your quality of life and the amount of exercise you can do and can impact on your diagnosis in terms of morbidity and mortality.”
The condition is usually brought on by physical exertion, emotional stress or extreme temperatures when the demand for oxygen from the heart is greater than the blood supply available. A patient may go for a walk and the limited blood supply from hardened arteries means that the increased blood supply needed does not reach the heart causing cramp, or angina.
There is a high risk of morbidity associated with this condition.
Variant angina pectoris, or Prinzmetal’s angina, however, can occur when a person is at rest. It occurs as a result of coronary artery spasm and may occur frequently for six months or more.
Hardened Arteries
The build-up of cells, fat, cholesterol and other substances – together known as plaque – in the arteries can lead to blood flow being blocked, preventing supply to the heart and brain.
The inner walls of the arteries become narrow because of a build-up of plaque, causing hardening known as atherosclerosis.
It is a slow, progressive disease which may begin in childhood. Why it starts is unknown but it may be due to high cholesterol and triglyceride levels in the blood, high blood pressure and smoking.
Deposits build up on the artery wall, and may stimulate the cells in the wall to produce further substances adding further layers of blockage. Fat builds up around and within these cells causing narrowing, or stenosis.
Thickening of the arteries can reduce the blood flow severely starving the blood supply to the heart and brain. A blood clot can lodge which completely blocks off the artery. Most commonly found in the legs, pelvis and abdominal arteries
The first sign of peripheral arterial disease is pain in the calf muscles, thighs or buttocks when walking or exercising. As it progresses, the pain may become continuous and prevent sleeping.
Narrowing of the arteries supplying blood to the heart can cause angina or heart attack.
Blockage of arteries to the neck can interfere with the flow of blood to the brain and may cause stroke.
Many people over the age of 60 will have some degree, irrespective of risk factors, of coronary artery narrowing.”
Risk factors include smoking, high cholesterol levels, diabetes and obesity. Family history and high blood pressure are also implicated and a combination of factors worsens a person’s chances of developing atherosclerosis.
High Blood Pressure, Or Hypertension
Increases the risk of heart attacks, strokes, kidney failure, damage to the eyes, congestive heart failure and atherosclerosis. It causes the heart to work harder than normal putting both the heart and arteries at greater risk of damage.
There are often no external signs of high blood pressure, leading many people to have it for years without noticing. When combined with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke is several times higher.
If high blood pressure isn’t treated, the heart may have to work harder and harder to pump enough blood and oxygen to the body’s organs and tissues to meet their needs.
Diabetes and diet, particularly salt, are key causes of hypertension. Use of oestrogen-based contraceptive pills and hormone replacement therapy has been implicated as a cause.
When it is forced to work harder than normal for an extended time, the heart enlarges and weakens. While a slightly enlarged heart may work well, one that is significantly enlarged has a hard time meeting the demands put on it.
Arteries also suffer the effects of high blood pressure, becoming scarred, hardened and less elastic. Though this hardening of the arteries often occurs with age, high blood pressure accelerates the process. The hardened or narrowed arteries are unable to supply the amount of blood the body’s organs need, preventing them working effectively.
Another risk is that a blood clot may lodge in an artery narrowed by atherosclerosis, blocking blood supply.
Hypertension exists where the pressure at which blood is pushing against blood vessel walls is consistently above average.
It is measured in millimetres of mercury (mm Hg) and is defined in an adult as a blood pressure equal to or above 140mm Hg when the heart is contracting – systolic – and 90mm Hg when the heart is relaxing – diastolic.
Untreated high blood pressure can cause the heart to become abnormally large and less efficient – ventricular hypertrophy, causing heart failure and increased risk of heart attack.
In 90-95% of cases, the cause is unknown, in the remaining cases, high blood pressure is a symptom of a recognisable underlying problem such as a kidney abnormality, tumour of the adrenal gland or congenital defect of the aorta. When the root cause is corrected, blood pressure usually returns to normal. This type of high blood pressure is called secondary hypertension.
Disturbed Heart Rhythm, Or Arrhythmia
Occurs when the heart’s natural pacemaker develops an abnormal rate or rhythm, the normal blood flow is blocked or another part of the heart takes over as pacemaker.
Normal heartbeats occur at between 60 and 100 beats per minute for adults when resting.
They start in the right atrium, or upper chamber, of the heart sending an electrical signal which spreads to a connecting point to the ventricles, or lower chambers. The atria contract first, followed by the ventricles a fraction of a second later.
Too slow or too fast
Heartbeats can be too slow, known as bradycardia. A heartbeat of less than 60 beats per minute can cause fatigue, dizziness, light-headedness or fainting.
A heart beat which is too fast, tachycardia, can produce palpitations and is also responsible for dizziness, light-headedness and fainting. Rapid heart-beating in the ventricles can be life threatening.
Ventricular fibrillation, where the lower chambers quiver and the heart cannot pump any blood, leads to collapse and sudden death unless medical treatment is immediately provided.
In atrial fibrillation, where the two upper chambers of the heart – the atria – quiver instead of beating properly, blood is not properly pumped out of the heart. As a result it may form clots and if the clot becomes lodged in an artery in the brain, a stroke may result.
The American Heart Association says around 15% of strokes are caused in this way.
Symptoms
Patients may themselves identify problems with their heart rate or symptoms.
Professor John Camm, professor of clinical cardiology at St George’s Hospital, London, said: “Often the patient with a cardiac arrythmia will make specific complaints such as ‘I feel my heart beating rapidly’ or ‘I feel my heart beating slowly and irregularly’.
“Sometimes they have taken their pulse and complain of a slow or fast pulse rate. “And sometimes they have symptoms which are related to their fast pulse rate such as feeling faint or blacking out. Similarly, a slow heart rate can have these symptoms.”
There are three main types of heart muscle disease, all of which can cause a heart attack.
The most common – hypertrophic cardiomyopathy – is the biggest cause of sudden death in people aged under 30.
The warning signs of heart muscle disease – cardiomyopathy – are sudden loss of consciousness, rapid palpitations (arrhythmias), pain in the chest (angina) and unexplained breathlessness.
Primary cardiomyopathy has no specific causes, unlike secondary cardiomyopathy which may be caused by hypertension, heart valve disease, artery diseases or congenital heart defects as well as disease affecting areas other than the heart.
Hypertrophic cardiomyopathy
The heart muscle thickens greatly without any obvious cause. In most cases the disease is hereditary, resulting from a gene abnormality. The disease is thought to affect at least 125,000 people in the UK.
The muscle mass of the left ventricle is larger than it should be, causing the mitral valve to touch the dividing wall between the two sides of the heart – the septum. The effect of the narrowing of the passage is to obstruct the blood flow out of the heart. The valve may leak.
The muscle is stiff and has difficulty relaxing, increasing the amount of pressure required to expand when blood flows into the heart. This reduces the blood holding capacity of the heart.
The condition can be present in the foetus and cause stillbirth, or may develop in infancy. But, more usually, it develops during childhood or early adulthood.
Dilated Cardiomyopathy
Dilated, or congestive, cardiomyopathy is more common and occurs due to enlarging and stretching of the heart cavity, weakening the heart so it does not pump normally. The heart muscle becomes weak and too flexible, preventing it pumping blood efficiently around the body.
Breathlessness results as fluid builds up in the lungs, congesting them. This is called left heart failure.
There may also be right heart failure, where fluid accumulates in the tissues and organs of the body, usually the legs and ankles, and the liver and abdomen.
The cause of the condition is unknown in many cases, but it can be caused by a virus, auto-immune diseases such as rheumatoid arthritis, excessive consumption of alcohol or, rarely, as a result of pregnancy – peri-partum cardiomyopathy.
Shortness of breath, palpitations, tiredness, swollen ankles and angina are common symptoms. Blood clots often form because the blood is flowing more slowly through the heart.
Arrhythmogenic Right Ventricular Cardiomyopathy
Heart muscle is replaced by fibrous scar and fatty tissue – the right ventricle tends to be most affected. The right side of the heart may first thicken and later dilate – become thinner. It may lead to disordered electrical activity, and in some cases problems with the heart’s pumping action.
Restrictive Cardiomyopathy
Restrictive cardiomyopathy is the least common form and occurs when the middle layer of the heart cavity wall – the myocardium – is excessively rigid, impairing the filling of the ventricles with blood between heartbeats.
Diagnosis and treatment
The disease can only be identified by screening and the Cardiomyopathy Association in the UK argues this should be extended – currently at risk families are checked.
Conditions are diagnosed using an electrocardiogram, which measures heart beats, and an echocardiogram, which produces a picture of the heart showing any thickening of the muscle.
Cardiac catheterisation, exercise testing, Holter monitoring and other tests may also be necessary.
Complications include blood clots, heart failure, disturbed heart beats and sudden death.
Heart valve disease
Usually develops over time, affecting people aged 60 or over, but it can be the result of an infection which “chews up” the valve in a matter of days.
The condition is often present at birth (congenital heart disease), the child being born with valves made of two parts rather than the usual three. Gradually the valve wears and becomes thicker to the point where it has to be replaced.
Rheumatic fever used to be a common cause, but as the illness is now rare the effect of bacteria in damaging the valve, preventing it opening or closing properly, is now rare.
Acute infection (endocarditis), sometimes as a result of an abcess of a tooth, is however still a common cause of valve disease. Bacteria can destroy the valve in as little as a week.
Flow of blood
If one or more of the four heart valves are diseased or damaged it can affect the flow of blood in two ways.
If the valve does not open fully, it obstructs the flow of blood – known as valve stenosis. If the valve does not close properly, it will allow blood to leak backwards – called valve incompetence or valve regurgitation.
Both stenosis, a narrowing which makes the heart pump faster to get blood past the obstruction, and incompetence, which means the heart has to do more to pump the required volume of blood forwards, put extra strain on the heart.
The blood behind the affected valve will also be under increased pressure, called back pressure, leading to a build-up of fluid in the lungs or lower part of the body, depending on the valve affected.
Symptoms include tiredness or breathlessness when exercising, swelling of the ankles and legs, dizziness or fainting in extreme cases. Angina can occur.
Short of breath
Professor Gianni Angelini, British Heart Foundation professor of cardiac surgery at the University of Bristol, said: “You will have a patient who goes to see the GP and says suddenly he has noticed he is short of breath.
“He can’t do things he was able to do before. He can’t climb up stairs without getting short of breath, without having to stop.”
An electrocardiogram of the heart will be taken followed by an echocardiogram to give a picture of the heart. If valve disease is found, treatment with drugs may be used to control the problem, or – in severe cases – heart valve replacement may be necessary. There is a 5% chance of a patient dying after valve replacement surgery. Risks are less for aortic valve replacement.
Congenital heart defects
Are present in about 1% of live births and are the result of development problems during pregnancy, sometimes as a result of a viral infection such as rubella contracted by the mother.
Alcohol, illegal drugs and over the counter medicines can also cause defects.
Congenital heart defects take the form of holes between the chambers, blockages in the pathways from the heart to the lungs or the body, or abnormal connections between the chambers and vessels of the heart.
Diagnoses
Diagnoses can be made by scans taken during pregnancy but are usually made in the first days or weeks after birth. Diagnosis may not though be made until much later in life.
Professor Robert Anderson, professor of paediatric cardiac morphology at the Institute of Child Health in London, said: “We are making more and more diagnoses before the child is born.
“Scans are now done at 12 weeks and at 20 weeks. Suspicion of problems can be risen and probably now when this is referred to tertiary centres, we can diagnose two-thirds of the overall proportion of lesions within the heart.”
This allows parents to consider whether they want the pregnancy to continue and to prepare themselves if they do decide to continue, he said.
Septal defects – holes in the heart
Holes in the heart can occur in the upper chambers – atrial septal defects – or lower chambers – ventricular septal defects. Or they can exist between all four chambers – atrioventricular septal defects.
Where the hole occurs in the great artery, the defect is called a patent arterial duct. The holes are part of the circulation system in the foetus but should close up after birth. More complex conditions include Tetralogy of Fallot, which is one cause of the condition cyanosis, commonly known as “blue babies”.
In Tetralogy of Fallot, the baby has a large hole in the heart, allowing blood to pass from the right ventricle to the left without going through the lungs. There is a narrowing at or just below the pulmonary valve, the right ventricle is more muscular than normal and the aorta lies directly over the hole – the ventricular septal defect.
Babies may have rapid breathing or fall unconscious. Older children may become short of breath and faint. Surgery may be needed to increase blood flow to the lungs with a shunt, linking the aorta and the pulmonary artery. The child is able to develop and the defect can be corrected later.
Other causes of “blue babies” include defective pulmonary veins, which do not come back to the heart, or arteries coming out of the heart which are connected to the wrong ventricles,transposition.
With transposition most of the blood returning from the heart to the body is pumped back without first going to the lungs.
An arterial switch operation may be necessary to reconnect the arteries correctly.
With holes in the heart, oygenated, red blood which has come from the lungs passes into the right side of the heart where it mixes with bluish blood and is sent back to the lungs. The heart is put under extra strain, potentially causing it to enlarge and causing high blood pressure and blood vessel damage. Growth and nourishment are affected.
Holes in the heart are closed with one or two patches and the single valve is divided into two. Blood circulation should be returned to normal but the reconstructed valve may not work normally.
If the defect is too complex to repair in infancy, pulmonary artery banding may be used to reduce blood flow and high pressure in the lungs – pulmonary hypertension. The band is later removed and surgery carried out.
Obstruction defects
The obstruction, called stenosis, can be of the valves between the upper and lower chambers of the heart – atrioventricular valvular stenosis.
More frequently, the obstruction is between the ventricles and trunks coming from them – arterial valvular stenosis.
This can be either the valve to the lungs – pulmonary valvular stenosis, in which case the right ventricle must pump harder than normal – or the valve to the body – aortic valvular stenosis, in which it is hard to pump blood to the body.
Balloon valvuloplasty is usually used to correct pulmonary valvular stenosis but open heart surgery may be necessary.
Only severe aortic stenosis requires surgery and some children may have the condition without showing any symptoms. The obstruction can also be within the vessels themselves – aortic coarctation. In this case the narrowing is within the artery and effects supplies of blood to different parts of the body. This defect may not be picked up until the patient is quite old.
Rarely, only one ventricle is present or both the pulmonary artery and aorta come from the same ventricle. The right or left side of the heart may be incompletely formed, known as hypoplastic heart.
STROKE
There are two types of stroke – those caused by blood clots in the brain and those that occur when blood vessels burst. In both cases, the brain is starved of oxygen, damaging or killing cells. Sufferers are often left with difficulty talking, walking and performing other basic tasks.
A burst vessel accounts for 20% of strokes, a clogged vessel (where a clot may lodge) accounts for 80% of strokes
A blockage is called a cerebral thrombus or cerebral embolism and can be caused by atherosclerosis – hardening of the arteries.
In both types of stroke – those caused by blood clots and those caused by burst blood vessels – blood supply to the brain is interrupted, depriving the cells of oxygen and other nutrients. The cells are then damaged or die.
Mini-strokes, or transient ischaemic attacks (TIAs), may be a warning sign of an imminent full-blown stroke.
Embolic
In an embolic stroke, a blood clot – or embolus – forms somewhere in the body, usually the heart, and travels through the bloodstream to the brain. Once in the brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke.
Thrombotic
In the other form of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain – a thrombus. The process leading to this blockage is known as thrombosis and strokes caused in this way are called thrombotic strokes.
In atrial fibrillation, where the two upper chambers of the heart – the atria – quiver instead of beating properly, blood is not properly pumped out of the heart. As a result it may form clots and if the clot becomes lodged in an artery in the brain, a stroke may result.
The American Heart Association says arond 15% of strokes are caused in this way.
Blood clot strokes can also happen as the result of unhealthy blood vessels clogged with a build up of fatty deposits and cholesterol. The body regards these build ups as multiple, tiny and repeated injuries to the blood vessel wall and reacts as it would to bleeding from a wound, by forming clots.
- The symptoms of stroke:
- Sudden numbness or weakness of the face, arm or leg, particularly if it is on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden difficulty with walking, dizziness, loss of balance or co-ordination
- Sudden trouble seeing in one or both eyes
- Sudden severe headache with no known cause
Anyone identifying themselves or friends or family as having a stroke should call emergency services, not a GP, as any delay reduces the chance of a full recovery. The speed of treatment after a stroke is extremely important as the longer the brain cells are deprived of oxygen, the more damage they will suffer.
Treatment
Clot-busting drugs can be used in the first minutes or hours – up to a maximum of three hours – after an ischaemic stroke to dissolve the clot. After this time aspirin, which is not as powerful, may be given.
Survival rates are better for patients in specialist stroke units, because of the expert nature of staff and early use of rehabilitation, but such units are not always available. Rehabilitation programmes will be given to most stroke patients to help them recover lost mobility and speech.
Stroke – haemorrhagic
In around 20% of cases, strokes are caused by ruptured blood vessels leaking blood into the brain – haemorrhagic strokes.
Both types of stroke – those caused by blood clots and those caused by burst blood vessels – interrupt the supply of blood to the brain, depriving the cells of oxygen and other nutrients. The cells are then damaged or die.
Strokes caused by the breakage or “blow-out” of a blood vessel in the brain are the result of a cerebral aneurysm – ballooning of a weakened blood vessel in the brain – which is left untreated, high blood pressure, or a cluster of abnormally formed blood vessels (arteriovenous malformation).
Aneurysms develop over a number of years and do not usually cause detectable problems until they break.
Types of haemorrhagic stroke
There are two types of haemorrhagic stroke - subarachnoid and intracerebral.
In an intracerebral haemorrhage bleeding occurs from vessels within the brain itself. Hypertension, or high blood pressure, is the primary cause of this type of haemorrhage.
In subarachnoid haemorrhage, an aneurysm bursts in a large artery on or near the delicate membrane surrounding the brain. Blood spills into the area around the brain which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid.
The symptoms of stroke are the same as above.
Treatment
The speed of treatment after a stroke is extremely important as the longer the brain cells are deprived of oxygen, the more damage they will suffer.
Clot-busting drugs and aspirin must not be given to patients who have suffered a haemorrhagic stroke. A CT scan or MRI scan will identify the type of stroke suffered. Treatment of haemorrhagic stroke is less developed than that of ischaemic stroke.
A Medical Research Council trial is currently underway into treatment to remove blood clots surgically and drugs which prevent damage to brain cells during haemorrhages are being tested.
Survival rates are better for patients in specialist stroke units, because of the expert nature of staff and early use of rehabilitation, but such units are not always available.
Rehabilitation programmes will be given to most stroke patients to help them recover lost mobility and speech.
Conclusion
Not great reading ! how can you prevent any of these heart diseases from occurring ?
Well, as you will notice there are some types of heart disease that you cannot be responsible for, or do anything about, such as those you were born with.
Of course, I would say here that it starts with the parents, all parents should be in a completely fit and healthy state before they consider trying to conceive this would reduce the risk of their beautiful child being in a compromised state of health during its life – who could ask for more than that, a great start in life gives greater opportunities.
Those diseases we can be responsible for start with what we are eating and drinking and of course smoking.
I have outlined in my books, the website and articles contained a better way to a healthy heart and of course a life full of health and vitality.
Who could not want that ! please read on or contact me for further help.
