Cardiac Screening
The key to preventing cardiovascular disease, also called coronary artery disease (CAD), is managing your risk factors, such as high blood pressure, high total cholesterol or high blood glucose. But how do you know which risk factors you have? The best way to find out is through screening tests during regular doctor visits.
Regular cardiovascular screening is important because it helps you detect risk factors in their earliest stages. You can treat the risk factor with lifestyle changes and pharmacotherapies, if appropriate, before it ultimately leads to the development of cardiovascular disease.
Key screening tests includes:
- Blood Pressure
- Cholesterol profile
- Diabetes
- Body weight
- Smoking history
- Family history
Investigative tests may include:
- Blood tests
- ECG
- Echocardiogram
- CT coronary Calcium score
- 24 hour Blood pressure monitor
- Exercise stress test
It’s normal to get out of breath when you’ve overexerted yourself, but when breathlessness comes on suddenly and unexpectedly, it’s usually a warning sign of a medical condition. This is commonly either suggest trouble with your lungs or your heart, sometimes both reasons may co-exist.
Cardiac causes for breathlessness:
Scilent Hear Attack
Heart attack occuring without experiencing all the obvious symptoms, such as chest pain and overwhelming anxiety. In this case, shortness of breath may be the only warning sign you’re having a heart attack. If you or your doctor think this is the case, they’ll give you aspirin and admit you to hospital straight away.
Heart failure
Hear failure can also cause breathing difficulties. This life-threatening condition means your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly. It leads to a build-up of water inside the lungs, which makes breathing more difficult. This can be a heart muscle problem or heart valve failure.
Breathlessness
Breathlessness could also relate to a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate).
Investigations:
- Blood tests
- CXR
- ECG
- Echocardiogram
- Exercise Stress ECG
- 24hour ECG
See Angina and Heart Attack
Faints and blackouts
The medical term for fainting is syncope. Fainting is a sudden loss of consciousness, usually temporary and typically caused by a lack of oxygen in the brain. The brain oxygen deprivation has many possible causes, including hypotension (low blood pressure).
The following words or phrasal expressions also mean to faint: to pass out, to black out and loss of consciousness.
Sometimes syncope may be just that – a fainting episode with no medical importance. On some occasions, however, it may be caused by a serious illness, condition or disorder. Every case of fainting should be treated as a medical emergency until the cause is known and signs and symptoms have been treated. Anybody who has recurring fainting episodes should contact their doctor.
The following signs and symptoms may precede a fainting episode:
- Feeling warm or hot
- Light-headedness, dizziness, a floating feeling
- Nausea
- Sweating
- Vomiting
- Yawning
- A feeling of heaviness in the legs
- Blurred vision
- Confusion
When a person faints, the following signs may be evident:
- The individual may be falling over
- The patient may be slumping
- The person may be unusually pale
- There may be a drop in blood pressure
- There may be a weak pulse
There are many causes and reasons that may cause faints and blackouts including syncope including neurological, metabolic and cardiovascular disorders.
Cardiac syncope – an underlying heart problem causes a drop in blood/oxygen supply to the brain. Possible conditions include:
- Arrhythmias – abnormal heart beats, too fast, too slow or irregular.
- Valve Stenosis – a blockage of the heart valves
- Hypertension – high blood pressure
- Hypotension – sudden drop in blood pressure
- A heart attack – a heart muscle dies because it does not get enough blood (oxygen)
Investigations:
- Detail history and examination
- Blood tests
- ECG
- 24 hour ECG/7 day ECG
- Echocardiogram
- Exercise Stress ECG
Palpitations and heart rhythm disorders
Heart palpitations are a feeling that your heart is beating too hard or too fast, skipping a beat, or fluttering. You may notice heart palpitations in your chest, throat, or neck.
Heart palpitations can be bothersome or frightening. They usually aren’t serious or harmful, though, and often go away on their own. Most of the time, they’re related to stress and anxiety or to consumption of stimulants such as caffeine, nicotine, or alcohol. Palpitations also often occur during pregnancy.
In rare cases, palpitations can be a sign of a more serious heart condition. Therefore, if you have heart palpitations, make arrangements to see your doctor. And seek immediate medical attention if along with palpitations, you experience shortness of breath, dizziness, chest pain, or fainting.
After taking your medical history and conducting a physical exam, your doctor may order tests that can either confirm or rule out an underlying cause. If an underlying cause is found, the right treatment can reduce or eliminate palpitations. If your palpitations are not related to an underlying cause, lifestyle changes, including stress management and the avoidance of common triggers, can help prevent them.
Causes of Heart Palpitations
Many things can cause heart palpitations. In the vast majority of cases, the cause is either related to your heart or is unknown. Non-heart-related causes of palpitations include:
- Strong emotions such as anxiety, fear, or stress; palpitations often occur during panic attacks.
- Vigorous physical activity
- Caffeine, nicotine, alcohol, or illegal street drugs such as cocaine and amphetamines
- Medical conditions, including thyroid disease, a low blood sugar level, anaemia, low blood pressure, fever, and dehydration
- Hormonal changes during menstruation, pregnancy, or the peri-menopausal period; sometimes, palpitations during pregnancy are signs of anaemia.
- Medications, including diet pills, decongestants, asthma inhalers, and some drugs used to prevent arrhythmias (a serious heart rhythm problem) or treat an underactive thyroid
- Certain herbal and nutritional supplements
- Abnormal electrolyte levels
Palpitations can also be related to underlying heart disease. When they are, palpitations are more likely to represent arrhythmia.
Heart conditions associated with palpitations include:
- Prior heart attack
- Coronary artery disease
- Other heart problems such as congestive heart failure, heart valve problems, or heart muscle problems
Investigations:
- History and examination
- ECG
- 24 hour ECG/7 day ECG
- Echocardiogram
Heart Attack
The coronary arteries supply blood to the heart muscle. When the coronary arteries become narrow or blocked, blood flow to the heart is reduced. This decrease in blood flow to the heart deprives the heart muscle of oxygen.
Heart attack (also called myocardial infarction) is when part of the heart muscle is damaged or dies because it isn’t receiving oxygen. Most heart attacks are caused by a blockage in the coronary arteries.
If you suspect symptoms of heart attack, you should call for an ambulance or seek immediate medical attention.
The main function of the heart is to deliver the oxygen-rich blood to every cell in the body.
The arteries are the passageways through which the blood is delivered and the veins are the passageways through which the blood is collected and returned to the heart.
The coronary arteries supply blood to the heart muscle. When the coronary arteries become narrow or blocked, blood flow to the heart is reduced. This decrease in blood flow to the heart deprives the heart muscle of oxygen.
Heart attack (also called myocardial infarction) is when part of the heart muscle is damaged or dies because it isn’t receiving oxygen.
Risk factors
Risk factors for heart attack include
- Family history
- Hypertension (High Blood Pressure)
- High Cholesterol or other fat levels in blood
- Inactive lifestyle- Obesity/ overweight/ lack of exercise
- Diabetes (High blood sugar)
- Cigarette Smoking
- How will you feel?
Chest pain is the most common complaint in heart attack. Unlike angina, pain does not subside on resting.
However, the symptoms may be different for example some of the following;
- Fullness, uncomfortable pressure, squeeze in the middle of the chest
- Tightness, burning or a heavy weight over your chest
- Pain may radiate to your shoulders, neck, arms, upper abdomen, back or jaw.
20% of the patients with heart attack have no pain. This is seen in diabetics, high blood pressure, and elderly patients.
Heart attack is a medical emergency and if you suspect symptoms of heart attack, you should call for an ambulance or seek immediate medical help.
Complications
Complications depend upon the location and extent of the heart damage (due to blocked blood supply). Early intervention and treatment could prevent these complications.
Cardiac arrhythmias
Cardiac arrhythmias are disruptions in the natural rhythm of the heartbeat.
Cardiac Failure
Here the heart fails to pump blood to meet the metabolic demands of the body.
Pericarditis
Pericarditis is the inflammation of the pericardium, the outer covering of the heart that acts as a shock absorber for the heart.
Recurrent heart attacks
Increased risk of heart attacks and angina in the future.
Blood clots (Thromboembolism) and strokes.
Blood clots may be formed due to irregular rhythms and prolonged immobility. You may be prescribed blood-thinning agents that need to be monitored with regular blood tests.
Investigations
Heart attack is a medical emergency and if you suspect symptoms of heart attack, you should call for an ambulance or seek immediate medical help.
The following tests may be conducted in the emergency department or at the hospital.
- Blood Tests
- Electrocardiogram (ECG)
- Echocardiogram
- CT Coronary Calcium score and CT coronary angiogram
- Coronary Angiography (Cardiac Catheterisation)
Management
In angina, the blood supply to the heart is reduced and in heart attack the blood supply is blocked. Heart attack treatment should start as soon as possible to prevent complications and irreversible damage to the heart and always require admission to hospital.
If heart attack is confirmed then immediate treatment may include
- Relieve anxiety and shock
- Pain relief
- Oxygen
- Thrombolytic or blood thinning treatment to break down the clot
- Medications to stabilise the heart rhythm
- Angioplasty or Surgery to restore the coronary blood flow
General Treatments Include
- Lifestyle modifications
- Medications
- Procedure or Surgery
Lifestyle Modifications
The following life style modifications can help to prevent or lower your risk for heart disease and heart attack and improve your heart health:
Healthy Diet Choices-eating a low fat, low salt, low cholesterol diet
Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
Exercise- increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well being. Always discuss with your doctor before beginning any new exercise program.
Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
Diabetes Control- Take your diabetic medications, check with your doctor for exercises and physical activity as well as nutrition advice.
Medications
Along with life style modification, medications may be needed to control symptoms and improve the heart health. More than one medication may be prescribed. Some common coronary artery disease medications are listed below.
- Aspirin and Nitrates (GTN)
- ACE (angiotensin converting enzyme) and AIIA (Angiotenin 2 Antagonist)
- Beta-blockers
- Statins
- Calcium channel
- Anticoagulants or blood thinning tablets
Invasive intervention and Surgery
When lifestyle changes and medications are not sufficient to control angina, your doctor may suggest surgery or invasive procedures. The following procedures improve blood flow to the heart to relieve the chest pain and may prevent a heart attack in the future.
Angioplasty and Stent Treatment: In this procedure, a thin tube is threaded into the coronary arteries via a blood vessel in the groin, in a similar procedure to cardiac catheterization. A small balloon attached to the end of the tube is inflated, which widens the blocked portion of the artery and allows increased blood flow to the affected part of the heart muscle. Angioplasty may be done with or without stenting. This is carried out under Local Anaesthetic by your cardiologist.
Coronary Artery Bypass Graft (CABG surgery) – the coronary artery blockage is bypassed with a section of vein taken from the leg, chest or from the forearm. This is carried out under General Anaesthetic by a surgeon.
Cardiac Rehabilitation
Cardiac rehabilitation is a clinically supervised program to help heart patients recover and regain their overall physical and mental functioning. This helps to prevent recurrent heart attacks.
Cardiac rehabilitation programs include education about cardiac health, lifestyle modifications, psychological support, nutritional advice and much more.
Prevention
The following life style modifications can help to prevent or lower your risk for heart disease and heart attack and improve your heart health:
Understand all about heart attack, risk factors, symptoms, related conditions, etc.
- Healthy Diet Choices-eating a low fat, low salt, low cholesterol diet
- Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
- Exercise- increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well being. Always discuss with your doctor before beginning any new exercise program.
- Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
- Treat related conditions, such as high blood cholesterol, high blood pressure, diabetes, obesity & overweight.
- Regular health checkup and follow your doctors advice.
- Heart disease is preventable and the actions you take to reduce your risk of heart disease by making lifestyle changes will increase your chances for a long and healthy life.
Angina
Angina Pectoris (“Angina”) is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood.
Angina is a common symptom of coronary artery disease that occurs when the coronary arteries are narrowed or blocked. It is usually relieved within a few minutes by resting or by taking prescribed angina medicine.
Important Note: Not all chest pain is angina and therefore should always be evaluated by a Physician.
The main function of the heart is to deliver oxygen-rich blood to every cell in the body.
The arteries are the passageways through which the blood is delivered and the veins are the passageways through which the blood is collected and returned to the heart.
The coronary arteries supply blood to the heart muscle. When the coronary arteries become narrow or blocked, blood flow to the heart is reduced. This decrease in blood flow to the heart deprives the heart muscle of oxygen. The heart responds to the lack of oxygen by sending out signs in the form of pain called angina.
Atherosclerosis is a condition in which fatty material is deposited along the walls of arteries. This fatty material (often called plaque) thickens, hardens, and may eventually block the arteries.
Atherosclerosis of the coronary arteries is the most common cause of angina.
Risk factors
Risk factors for atherosclerosis and angina include:
- Family history
- Hypertension (High Blood Pressure)
- High cholesterol or other fat levels in blood
- Inactive lifestyle- Obesity/ overweight/ lack of exercise
- Diabetes (High blood sugar)
- Cigarette smoking
Triggers
Physical exertion is the most common trigger for angina.
Others triggers include:
- Emotional stress
- Extreme cold or heat
- Heavy meals
- Alcohol consumption and cigarette smoking.
How will you feel?
Chest pain is the most common complaint in angina. However, the symptoms may be different.
For example:
- Fullness, uncomfortable pressure, squeezing sensation in the middle of the chest
- Tightness, burning, or a heavy weight over your chest
- Pain may radiate to your shoulders, neck, arms, upper abdomen, back or jaw.
- Breathlessness on exertion
Important Note: Not all chest pain is angina and therefore should always be evaluated by a Physician.
Diagnoses
To diagnose angina, your doctor may use one of more of the following:
- Medical History and Physical examination
- Questions about your symptoms, risk factors, personal history, and family history of any heart disease.
- Electrocardiogram (ECG)
- Exercise Tolerance Test (Stress ECG or Exercise Stress Test)
- Stress Echocardiogram
- Coronary Angiography (Cardiac Catheterisation)
Management
- Lifestyle modifications
The following life style modifications can help to prevent or lower your risk for heart disease and angina and improve your heart health:
Healthy Diet Choices-eating a low fat, low salt, low cholesterol diet
Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
Exercise- increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well being. Always discuss with your doctor before beginning any new exercise program.
Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
- Angina Medications
Along with life style modification, medications may be needed to control symptoms and improve the heart health. More than one medication may be prescribed.
Some common angina medications are listed on the left. Move your cursor over the medications to find out more.
- Aspirin
- GlycerinTriNitrate (GTN)
- Long-acting nitrates
- Beta blockers
- Calcium channel blockers Invasive Intervention or Surgery
o Statins
When lifestyle changes and medications are not sufficient to control angina, your doctor may suggest surgery or invasive procedures. The following procedures improve blood flow to the heart to relieve the chest pain and may prevent a heart attack in the future.
- Invasive Intervention and Surgery
Angioplasty and stent treatment (Also called Percutaneous Coronary Intervention or PCI)- In this procedure, a thin tube is threaded into the coronary arteries via a blood vessel in the groin, in a similar procedure to cardiac catheterisation. A small balloon attached to the end of the tube is inflated, which widens the blocked portion of the artery and allows increased blood flow to the affected part of the heart muscle. Angioplasty may be done with or without stenting.
Coronary Artery Bypass Graft CABG surgery – the coronary artery blockage is bypassed with a section of vein, taken from the leg or from the forearm.
Prevention
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
- Understand all about angina, risk factors, symptoms, related conditions, etc.
- Healthy Diet Choices-eating a low fat, low salt, low cholesterol diet
- Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
- Exercise- increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well being. Always discuss with your doctor before beginning any new exercise program.
- Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
- Regular health screenings and following your doctor’s advice.
- Heart disease is preventable and the actions you take to reduce your risk of heart disease by making lifestyle changes will increase your chances for a long and healthy life.
Hypertension
High blood pressure (hypertension) usually has no obvious symptoms and many people have it without knowing.
Untreated high blood pressure can lead to serious diseases, including stroke, heart disease and kidney failure.
The only way to know if you have high blood pressure is to have your blood pressure measured. All adults should get their blood pressure checked at least once every five years.
In some rare cases, where a person has very high blood pressure, they can experience symptoms, including:
- persistent headache
- blurred or double vision
- nosebleeds
- shortness of breath
In more than 90% of cases, the cause of high blood pressure (hypertension) is unknown but several factors can increase your risk of developing the condition.
Where there is no specific cause, high blood pressure is referred to by doctors as primary or essential hypertension.
Factors that can raise your risk of developing primary hypertension include:
- age – the risk of developing high blood pressure increases as you get older
- a family history of high blood pressure (the condition seems to run in families)
- being of African or Caribbean origin
- a high amount of salt in your food
- a lack of exercise
- being overweight or obese
- smoking
- drinking large amounts of alcohol
Known causes
About 10% of high blood pressure cases are the result of an underlying condition or cause. These cases are referred to as secondary hypertension.
Common causes of secondary hypertension include:
- kidney disease
- diabetes
- narrowing of the arteries (large blood vessels) supplying the kidneys
- hormonal conditions, such as Cushing’s syndrome
- conditions that affect the body’s tissue, such as lupus
- oral contraceptive pill
- painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- recreational drugs, such as cocaine, amphetamines and crystal methamphetamine
- herbal remedies, such as herbal supplements
High blood pressure usually has no warning signs or symptoms. Fortunately you can find out if you have high blood pressure by having your blood pressure checked regularly. Adults should have their blood pressure checked at least every five years.
How can I help prevent high blood pressure?
- Maintaining a healthy weight. Being overweight makes the heart work harder and raises blood pressure. For people who are overweight, even small amounts of weight loss can make a big difference in helping to prevent and treat high blood pressure.
- Getting regular exercise: People who are physically active have a lower risk of getting high blood pressure. The NHS advises doing at least 150 minutes of exercise a week.
- Cut down on salt: There’s a link between the salt we eat and blood pressure. Try to eat less than 6g of salt a day, about a teaspoonful.
- Drinking alcohol in moderation, if at all: Drinking too much alcohol can raise your blood pressure. The NHS says regularly drinking above recommended daily limits risks damaging your health. Men should not regularly drink more than three to four units a day. Women should not regularly drink more than two to three units a day.
- Reducing stress: Stress can make blood pressure go up. Over time, stress may contribute to the cause of high blood pressure. Relaxation therapy techniques and exercise can help reduce blood pressure.
- Limit caffeine: Blood pressure may be increased by drinking more than four cups of coffee a day. Consider going decaf. Remember, caffeine is also found in tea, cola, some energy drinks and even some medicines.
Medication used in patients with hypertension
- Beta-blockers
- ACEi/A2A
- Calcium Channel Blockers
- Diuretics
- Aspirin
- Statins
Investigations:
- Bloods tests
- Urine tests
- ECG
- CXR
- Abdominal Ultrasound scan
- 24 hour ambulatory Blood Pressure monitor
- Echocardiogram
Heart Failure
Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. In most cases heart failure is a chronic, long-standing, and ongoing condition but it can develop suddenly.
Causes
Heart failure results when the over worked heart muscle does not work as efficiently as it used to. Any factor that increases the heart workload may initiate heart failure. It is most commonly seen in old age and common causes are:
- Coronary Artery Disease- causes narrowed arteries that decrease the blood supply to the heart muscle.
- Previous heart attack- interferes with the heart muscle’s normal functioning.
- High blood pressure- causes the heart to work harder than usual.
- Other causes of heart failure include
- Valvular heart disease e.g., Aortic Stenosis
- Congenital heart defects
- Cardiomyopathy- disease of the heart muscle
- Lung disease
- Arrhythmias- irregular heartbeat
- Alcoholism
How will you feel?
The “failing” heart keeps working but not as efficiently as it should. People with heart failure can’t exert themselves because they become short of breath and tired.
Symptoms
- Fatigue
- Breathlessness and difficulty in breathing
- Weight gain due to fluid retention
- Inability to lie flat in bed due to fluid retention in lungs
- Swelling in legs (oedema)
It is useful to consult a doctor if you feel fatigue or sudden weight gain.
Aggravating factors
Any factor that increases the heart workload may aggravate existing heart failure or initiate heart failure.
- Arrhythmias (irregular heart beat)
- Anaemia (decreased hemoglobin in blood)
- Hormonal factors e.g., increased thyroid hormone
- Pregnancy
Diagnoses
Your doctor diagnoses Heart failure by medical history alone but may ask you to undergo a series of diagnostic tests.
- Medical History and Physical examination
- Chest X-ray
- Electrocardiogram (ECG)
- Echocardiogram
- Angiography (Cardiac Catheterisation)
Management
Heart failure management should start soon after diagnosis and includes the following
- Reduction of physical activity- to reduce demand on the heart
- Dietary modifications- low salt diet
- Restricting fluid intake
- Losing weight if overweight
- Quitting smoking
- Alcohol restriction
Heart failure medications
- Diuretics
- Beta-blockers
- ACE inhibitors
- Digoxin (Digitalis Glycosides)
- Spironololactone/Eplerenone
- Nitrates
Invasive intervention and Surgery
This may include implantation of a specialised pacemaker to resynchronise the chamber contraction of the heart to improve the hearts efficiency. This treatment is not suitable for all cases of heart failure. Restoration of the blood supply to the heart is vital if the cause is due to coronary artery disease and is usually by coronary stenting. Bypass surgery and valve surgery would be recommended if the condition is deemed severe and the cause due to valve function failure.
Prevention
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
- Understand all about heart failure, symptoms, related conditions, etc.
- Eat Healthy- Stick to a heart-healthy low cholesterol, low fat, and low sodium diet.
- Quit smoking- No matter how long you have smoked, when you quit, you lower your risk for heart disease. Also stop using any smokeless tobacco products as the chemicals in them affect the heart as well.
- Exercise – Exercising and being active are important and can reduce stress and help you sleep. Walking is always an easy way to begin. Check with your doctor before starting any new exercise program.
- Lose weight- If you are considered overweight or obese talk with your doctor about the best way for you to shed the extra pounds.
- Treat related conditions- such as high cholesterol, high blood pressure, diabetes, obesity, and being overweight.
Regular health screenings and following your doctor’s advice.
Valvular Heart Disease
Valvular heart disease is a common heart condition caused by malfunctioning heart valves. There are 4 valves in the heart that function to keep blood moving in one direction. When a valve is diseased or abnormal and doesn’t close completely, blood can back up instead of going forward. This is called regurgitation or “leaky valve”. When a valve opening is too narrow, the heart has to work harder to pump the blood throughout the body. This narrowing of the valve opening is called stenosis. Valvular Heart Disease is a serious condition that causes the heart to work harder. If left untreated Valvular Heart Disease can lead to Congestive Heart Failure, Cardiomyopathy, and even death.
Many patients with Valvular Heart Disease can successfully control their symptoms with medications, however medications cannot cure diseased or abnormal heart valves.
In some cases, patients are unable to tolerate the side effects of the medications or do not respond to the medications and require further intervention. In other cases, the valves are so diseased or abnormal there is no other option except to repair or replace the valve.
Heart valve surgery may be an option for these patients. Traditionally the surgery has been performed through a long chest incision with the breastbone or sternum split and ribs spread apart. Minimally invasive techniques for repairing or replacing diseased or abnormal valves have been developed that require a much smaller incision with partial or no splitting of the breastbone.
Heart Valves
The main function of the heart valves is to regulate and prevent the backflow of the blood.
There are four important valves in the heart
Tricuspid Valve
- The tricuspid valve regulates blood flow between the right atrium and the right ventricle.
- It prevents the backflow of blood to the right atrium when the right ventricle pumps blood to the lungs.
- Mitral Valve
- The mitral valve regulates the blood flow between the left atrium and the left ventricle.
- It prevents the backflow of blood to the left atrium when the left ventricle pumps blood through the aorta to the rest of the body.
Pulmonary Valve
- The pulmonary valve regulates the de–oxygenated blood from the right ventricle to the lungs for purification.
Aortic Valve
- The aortic valve regulates the oxygenated blood pumped from the left ventricle to the rest of the body.
The left side of the heart has to work harder than the right side because it functions to pump blood to the entire body, not just to the lungs. Because the Mitral and Aortic valves regulate blood flow in the left side of the heart, these valves are the most commonly replaced valves accounting for 98% of all valve replacement surgeries.
What is Valvular Heart Disease?
Valvular Heart Disease is a condition where one or more valves in the heart do not function properly. There are four valves in the heart that open and close to keep blood flowing in one direction. Malfunctioning valves can cause blood to back up instead of moving forward in one direction. This is referred to as regurgitation. Some valves have stiffened and narrowed over time making it more difficult to pump blood through the narrowed opening. This is referred to as stenosis. These conditions cause the heart to try and pump harder to move the same amount of blood. Over time, this extra workload takes it toll on the heart weakening the heart muscle, a condition called Cardiomyopathy.
Left untreated, Valvular Heart Disease will ultimately lead to heart failure.
Risk factors for Valvular Heart Disease include the following:
- Untreated strep throat that leads to Rheumatic fever
- Infection in the lining of the heart and valves called Infective Endocarditis
- Advancing age causing weakening of the valves or calcification of the valves
- Congenital heart disorders (occurring at birth)
- Coronary Artery Disease
- Myocardial Infarction or heart attack
Signs and Symptoms of Valvular Heart Disease may be mild, moderate, or severe and can include the following:
- Shortness of breath
- Swelling of lower extremities or abdomen
- Arrhythmia: fast or irregular heart beat
- Wet cough
- Palpitations
- Tiredness or lethargy
- Syncope or fainting
- Light-headed or faint
- Chest pain
- Blood clots
- No symptoms at all
A Cardiologist should evaluate all heart conditions for proper diagnosis and treatment.
Your Cardiologist will perform the following:
- Medical History
- Physical Examination
Diagnostic Studies may include some or all of the following:
- Blood tests
- Electrocardiogram (ECG)
- Chest X-Ray
- Echocardiogram
- Transoesophageal Echocardiogram
- Cardiac MRI
- Cardiac Catheterisation
Management
Valvular Heart Disease management depends on the following:
- Type of disease
- Severity of symptoms
- Underlying cause
- Your overall health
- The goals of treatment for Valvular Heart Disease are:
- Decrease workload on the heart
- Restore normal heart rhythm
- Prevent blood clots and strokes
Conservative Management Includes:
Ø Lifestyle Modifications
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
Healthy Diet Choices-Eating a low fat, low salt, low cholesterol diet while avoiding excessive intake of alcohol and caffeine.
Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
Reduce stress through exercise- Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of wellbeing. Always discuss with your doctor before beginning any new exercise program.
Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
Ø Medications
Along with life style modification for heart health, medications are needed to control symptoms of Valvular Heart Disease. More than one medication may be prescribed. Some common medications are listed on the left. Move your cursor over the medications to find out more.
- Anticoagulants
- Digoxin
- Ace Inhibitors
- Beta-blockers
- Calcium Channel Blockers
- Diuretics
- Antibiotics
Many Valvular Heart Disease patients have good results from medication and lifestyle changes. However, some patients are unable to tolerate the side effects of the medications used to treat the condition and others continue to have symptoms despite medical intervention. In some cases, the valve is so diseased the only option is surgical repair or replacement of the valve.
If conservative treatment options are unsuccessful in treating your Valvular Heart Disease and you are a candidate for the procedure, your surgeon may recommend a surgery called Minimally Invasive Heart Valve surgery.
The smaller incisions with Minimally Invasive Heart Valve surgery mean that fewer tissues are cut resulting in quicker healing and recovery.
Cholesterol Management
Cholesterol is a fatty substance that occurs naturally in the body. It performs several vital functions. It is needed to make the walls surrounding the body’s cells and is the basic material that is converted to certain hormones. Your body makes all the cholesterol you need. You need only a small amount of fat in your diet to make enough cholesterol to stay healthy.
The fat and cholesterol you eat are absorbed in the intestine and transported to the liver. The liver converts fat into cholesterol, and releases cholesterol into the bloodstream. There are two main types of cholesterol: low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) and high-density lipoprotein (HDL) cholesterol (the “good” cholesterol).
High levels of LDL cholesterol are linked to atherosclerosis, which is the accumulation of cholesterol-rich fatty deposits in arteries. This can cause arteries to narrow or become blocked, slowing or stopping the flow of blood to vital organs, especially the heart and brain. Atherosclerosis affecting the heart is called coronary artery disease, and it can cause a heart attack. When atherosclerosis blocks arteries that supply blood to the brain, it can cause a stroke.
High levels of HDL cholesterol actually protect against heart attacks and strokes by removing cholesterol from the arteries and bringing it back to the liver.
Because high cholesterol levels can cause atherosclerosis, doctors recommend that people keep their cholesterol levels within a specific range. In general, adults older than 20 should try to keep their total cholesterol level below 5 mmol/l.
Risk factors for cardiovascular disease:
- High LDL cholesterol level
- Diabetes
- Being a male older than 45
- Being a female older than 55
- Being a female with premature menopause
- Having a family history of premature coronary artery disease (a father or brother younger than 55 with coronary artery disease or a mother or sister younger than 65 with coronary artery disease)
- Smoking cigarettes
- Having high blood pressure
- Not having enough good cholesterol (high density lipoprotein or HDL)
If you have coronary artery disease, peripheral arterial disease or have had a stroke from atherosclerosis, your LDL cholesterol should be 2 mmol/l or less.
Most people with high cholesterol don’t have any symptoms until cholesterol-related atherosclerosis causes significant narrowing of the arteries leading to their hearts or brains.
About 1 out of every 500 people has an inherited disorder called familial hypercholesterolemia, which can cause extremely high cholesterol levels (above 7 mmol/l). People with this disorder can develop nodules filled with cholesterol (xanthomas) over various tendons, especially the Achilles tendons of the lower leg. Cholesterol deposits also can occur on the eyelids, where they are called xanthelasmas.
Investigations:
- Blood test including full Lipid profile, glucose, thyroid function.
- ECG
- Exercise Stress ECG
Coronary Artery Disease
What is Coronary Artery Disease?
Coronary Artery Disease (CAD) is usually caused from a condition called atherosclerosis. Atherosclerosis is a condition in which fatty material is deposited along the walls of arteries. This fatty material (often called plaque) thickens, hardens, and may eventually block the arteries.
Symptoms of CAD include chest pain (angina), shortness of breath, and, if left untreated…. heart attack!
CAD is the most common cause of angina and Heart Attack.
Risk factors:
- Family history
- Hypertension (High Blood Pressure)
- High Cholesterol or other fat levels in blood
- Inactive lifestyle- Obesity/ overweight/ lack of exercise
- Diabetes (High blood sugar)
- Cigarette Smoking
- Stress
- Menopause
- Non-compliance with medicines to treat hypertension and high cholesterol.
Coronary Heart Disease is the most common cause of Angina and Heart Attack.
Symptoms
Chest pain is the most common complaint in heart attack. Unlike angina, pain does not subside on resting.
However, the symptoms may be different:
- Fullness, uncomfortable pressure, squeeze in the middle of the chest
- Tightness, burning or a heavy weight over your chest
- Pain may radiate to your shoulders, neck, arms, upper abdomen, back or jaw.
- 20% of the patients with heart attack have no pain. This is seen in diabetics, high blood pressure, and elderly patients.
- Shortness of breath
Heart attack is a medical emergency and if you suspect symptoms of heart attack, you should call for an ambulance or seek immediate medical help.
Diagnoses
A Cardiologist should evaluate all heart conditions for proper diagnosis and treatment.
Your Cardiologist will perform the following:
- Medical History
- Physical Examination
Diagnostic Studies may include:
- Blood tests
- Electrocardiogram (ECG)
- Stress ECG Test
- Stress Echocarigram
- Coronary Angiography (Also called Angiogram or Cardiac Catheterisation)
Management
Lifestyle Modifications
- Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
Healthy Diet Choices-Eating a low fat, low salt, low cholesterol diet
- Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
- Exercise- Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well-being. Always discuss with your doctor before beginning any new exercise program.
- Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
o Diabetes Control- Take your diabetic medications, check with your doctor for exercises and physical activity as well as nutrition advice.
- Medications
Along with life style modification, medications may be needed to control symptoms and improve the heart health. More than one medication may be prescribed. Some common medications are listed on the left. Move your cursor over the medications to find out more.
- Aspirin
- Nitrates
- Digoxin
- ACE (angiotensin converting enzyme) inhibitor
- Long-acting nitrates
- Beta-blockers
- Calcium Channel Blockers
- Statins
- Anticoagulants
Atrial Fibrillation
Atrial Fibrillation (AF) is a very common heart condition caused by a malfunction of the heart’s electrical conduction system. This malfunction causes the upper chambers of the heart, the atria, to contract in an uncoordinated manner resulting in an irregular, and often fast, heartbeat. Atrial Fibrillation is a serious condition and is a major cause of stroke as well as a precursor for Congestive Heart Failure and Cardiomyopathy.
Most patients with AF can be successfully treated with medications, however some patients either cannot tolerate the side effects of the medications or do not respond to the medications and require further intervention.
One option for treating AF is a minimally invasive procedure called Ablation. Ablation treat AF by blocking the abnormal electrical impulses through the creation of scar tissue. The scar tissue creates a maze-like pathway for the electrical impulses to travel. Because the impulses cannot travel over scar tissue, Ablation promotes normal conduction of impulses through the proper pathway.
What is Atrial Fibrillation?
Atrial Fibrillation is an arrhythmia or irregular heartbeat caused from abnormal electrical impulses in the heart. This causes the atria, the upper 2 chambers of the heart, to fibrillate or quiver instead of beat in a regular pattern. This fibrillation often causes the heart to beat rapidly while pumping less efficiently. AF increases the risk of stroke 5-7x, weakens the heart muscle, a condition called Cardiomyopathy, and can lead to Congestive Heart Failure and even death.
There are 3 types of AF and treatment varies depending on the type:
Paroxysmal: This type of AF is intermittent, meaning it comes and goes. The heart rate converts spontaneously back to normal sinus rhythm without medical intervention. It may occur for seconds or over a period of days.
Persistent: This type of AF does not convert itself back to normal sinus rhythm but continues until medical treatment is administered or cardioversion is applied.
Chronic (Permanent): This type of AF is ongoing meaning the heart is always in AF. Converting the heart back to normal sinus rhythm is not possible.
Risk factors
- Aging: Over age 60 although it may occur at any age
- Affects more whites than blacks
- Affects more men than women
- Uncontrolled Hypertension (High Blood Pressure)
- Chronic lung disease
- Pulmonary embolism: blood clot in the lungs
- Diabetes
- Nerve conditions
- Excessive alcohol, caffeine, or tobacco intake
- Heart disease caused by high cholesterol
- Leaky heart valves
- Cardiomyopathy: Disease of the heart muscle
- Congestive Heart Failure
- Electrolyte imbalances
- Inflammation
- Viral infections
- Congenital heart disease
- Hyperthyroidism
- Family history
In many cases of AF, no cause can be identified and is described as Lone AF.
Signs and Symptoms:
- Palpitations: This is a sensation of abnormal heartbeats sometimes described as a “fluttering” feeling in the chest.
- Irregular pulse
- Shortness of breath with exertion
- Tiredness
- Syncope or fainting
- Light-headed or faint
- Chest Pain
- No symptoms at all
Diagnosis
A Cardiologist should evaluate all heart conditions for proper diagnosis and treatment.
- Medical History
- Physical Examination
Diagnostic Studies may include:
- Blood tests
- Electrocardiogram (ECG)
- Exercise Tolerance Test (Stress ECG or Exercise Stress Test)
- Chest X-Ray
- Echocardiogram
- Holter Monitor (24 hour ECG monitoring
Management
AF management depends on the following:
- Type of Atrial Fib
- Severity of symptoms
- Underlying cause
- Your overall health
The goals of treatment of Atrial fibrillation are:
- Restore normal heart rhythm
- Control the heart rate
- Prevent blood clots and strokes
Management Includes:
Ø Lifestyle Modifications
Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:
Healthy Diet Choices-Eating a low fat, low salt, low cholesterol diet while avoiding excessive intake of alcohol and caffeine.
Don’t Smoke-If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.
Reduce stress through exercise- Increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of wellbeing. Always discuss with your doctor before beginning any new exercise program.
Weight Loss-Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.
Ø Medications
Along with life style modification for heart health, medications are needed to control symptoms of Atrial fibrillation. More than one medication may be prescribed. Some common medications are listed on the left. Move your cursor over the medications to find out more.
- Anti-arrhythmia medications
- Anticoagulants
- Digoxin
- Beta-blockers
- Calcium Channel
Cardiac Myxoma and Tumours
Cardiac Myxoma is a tumour originating in connective tissue and is the most common tumour of the heart. It is usually located in the left or right atrium. An echocardiogram usually will reveal the tumour’s presence. Symptoms can include shortness of breath, weight loss, blood in the sputum, fever, loss of consciousness, and sudden death. Most Myxomas are benign (non-cancerous) and treatment involves surgical removal of the tumour.
Investigations and diagnosis include:
- History and physical examination
- ECG
- Echocardiogram
- Transoesophageal echocardiogram
- Cardiac MRI
- Cardiac catheterisation
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