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Save yourself from heart disease

save-yourself-from-heart-disease-23-04-12The UK has one of the highest rates of death from heart disease in the world – but new treatments could save many of those lives.

Heart disease is one of the UK’s biggest killers, but it needn’t be the case. We take a look at some of the most common conditions, how they can be avoided and if they do strike, how they can be treated…

Condition:

Heart attack

The heart is surrounded by three major coronary arteries that supply it with blood and oxygen. If a clot develops in one of these arteries, the blood supply to that area of the heart muscle will stop. This is a heart attack – in medical terms, a coronary thrombosis or myocardial infarction.

Symptoms of a heart attack can include severe chest pain, sometimes spreading to the arms – in particular the left arm – as well as the neck and jaw. Some sufferers feel sick, sweaty and breathless as well.

What causes it? Heart attacks usually occur when there is a build-up of cholesterol and fat (fatty deposits or plaques) in the artery walls. This is called atherosclerosis. The arteries become narrow and hardened as a result, their elasticity disappears and it becomes increasingly difficult for blood to flow through without obstruction. The fatty plaques can also rupture, causing blood to clot around the rupture. If blood can’t then flow past the clot to the necessary part of the body, the tissue eventually dies. These plaque ruptures are a common cause of heart attacks.

Major risk factors for heart attacks include a family history of atherosclerosis, high cholesterol levels, high blood pressure and smoking. Indeed, smokers are twice as likely to have a heart attack than non-smokers. What’s more, they are more likely to die as a result of a cardiac arrest. Gender plays a part, too, as men are more prone to heart attacks than women. Type 1 or Type 2 diabetes, stress, being overweight and lack of exercise are other key risk factors.

Treatment:

The most crucial issue is speed. Dialling 999 is a priority of course – but if a heart beat can be maintained until the ambulance arrives, this could make all the difference. Having a home defibrillator, such as Laerdal’s Heartstart (www.heartstart.co.uk), could save a life. So could issuing a 300mg tablet of aspirin, because this helps to prevent platelets (small blood cells) from sticking together around the clot that’s blocking the artery. At hospital, thrombolysis, often described as a clot-busting drug, is injected into the bloodstream to help dissolve the clot that’s blocking the artery.

Alternatively, an emergency operation can be performed to dilate the blocked coronary artery using a balloon. This is known as coronary angioplasty and is usually considered if, for some reason, the patient cannot receive thrombolytic medicine or has a sustained low blood pressure.

Beta-blockers may be prescribed after a heart attack to lower blood pressure and to reduce chances of another attack.

Condition:

Coronary artery disease and angina

A build-up of fatty deposits, called atheroma, can cause the coronary arteries to become narrowed or blocked. This build-up can restrict the amount of blood to the heart.

The main symptom of coronary artery disease is angina, which gives you a feeling of heaviness, tightness or pain in the middle of your chest that can affect your arms, neck, jaw, face, back or abdomen. Angina is most often experienced on exertion.

What causes it? Age is a major factor, as four out of five people who die from coronary heart disease are 65 or older. Men are more at risk than women and have attacks earlier in life. Death rates from heart disease for women are twice as high as those for all forms of cancer, and it increases as they approach menopause and continues to rise as they get older. Failure to exercise is a cause of coronary heart disease, as physical activity helps control cholesterol levels and, in some cases, lowers blood pressure. People who are overweight are more likely to develop heart disease and a stroke, even if they have no other risk factor, because excess weight puts extra strain on the heart. Drinking an average of more than one alcoholic drink a day for women, or more than two drinks a day for men, increases the risk of heart disease due to its effect on blood pressure. The higher the blood cholesterol level, the higher the risk of coronary heart disease too – particularly if combined with other risk factors.

Treatment

Beta-blockers reduce the amount of work the heart has to do because they slow the heart rate. This means they are very effective in preventing an attack of angina. Coronary angioplasty and stents (short tubes of stainless-steel mesh) are used to open clogged heart arteries. There are 23,500 angioplasties performed on patients with angina in the UK each year. Fatty tissue – atheroma – responsible for narrowing arteries, is squashed, allowing blood to flow more easily. A catheter is inserted into an artery under local anaesthetic in either the groin or the arm and guided using a screen to a coronary artery until its tip reaches the narrowed or blocked section. A balloon mounted on the end of the catheter is then inflated to a diameter of about 3mm, flattening the atheroma. A stent may be inserted into the part of the artery to be widened to prevent re-narrowing after angioplasty. In coronary bypass surgery, a blood vessel is grafted between the aorta – the main artery leaving the heart, and a point in the coronary artery beyond the blocked area. During the operation, a heart-lung bypass machine takes over the pumping of blood and breathing. More than 21,000 patients have this surgery in the UK each year, and the procedure has an excellent success rate. Around eight in 10 patients experience immediate and lasting relief.

Condition:

Heart rhythm disorders

Arrhythmias are problems that affect the electrical system, or ‘wiring’ of the heart muscle. Heart arrhythmias are very common and millions of people will experience an abnormal heart rhythm at some time during their lives. When it causes a noticeable change in the sound of a beat, it is often called a heart murmur. It also includes the condition atrial fibrillation when the heart beats quickly and irregularly.

What causes it? Heart rhythm disorders can affect anyone, regardless of age, gender or physical fitness, but lifestyle factors can increase risk. These include smoking, drinking excess alcohol, a sedentary lifestyle, obesity, an unhealthy diet and eating too much salt.

Treatment

The aim of treatments is to bring the heart rate back to a normal level. Drugs, including beta-blockers and Verapamil, the calcium channel blocker, are often used. Amiodarone is used mainly for atrial fibrillation. Anticoagulent drugs such as heparin and warfarin are often used to prevent clots from forming. Cardioversion is a treatment that delivers a small, controlled electrical shock to the heart – not in order to stop it completely but to interrupt an arrhythmia so that the normal electrical pathway can take over again. An artificial pacemaker may be needed by patients who have irregular heart rates or rhythms. A pacemaking system has a pulse generator and electrode leads. Electrical impulses are conducted down the electrode lead to the heart, and that, in turn, will stimulate the heart beat. An implantable cardioverter defibrillator (ICD) is a small battery-powered device that is able to give the heart electrical shocks. It is usually implanted under the collar bone in those who have had a previous life-threatening abnormal heart rhythm and are at risk of suffering another one.

Image: Shutterstock


This article was first published in at home’s ’Ask the Doctor’ with Dr Christian Jessen in March 2012. [Read the digital edition here]


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