Choosing your consultant: cardiology
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 strike, how they can be treated…
The UK has one of the highest rates of death from heart disease in the world – one British adult dies from it every three minutes. Cardiology deals with the investigation, diagnosis and treatment of disorders of the heart and blood vessels. The symptoms of heart conditions include chest pain, palpitations, breathlessness and blackouts. You are likely to be treated by a cardiologist if you have these symptoms as they can indicate that you have narrowed or blocked coronary arteries, damaged or faulty heart valves or a weak heart muscle.
Coronary artery disease and angina A build-up of fatty deposits, called atheroma, can cause the coronary arteries to narrow or get blocked and this can restrict the amount of blood to the heart. The main symptom of coronary artery disease is angina, which brings a feeling of tightness or pain in the middle of your chest that can affect your arms, neck, jaw, face, back or abdomen. Angina is 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 levels of cholesterol and, in some cases, lowers blood pressure. People who are overweight are more likely to develop heart disease and 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.
Beta-blockers reduce the amount of work the heart has to do because they slow down the heart rate. This means they are very effective in preventing an attack of angina. Coronary angioplasty and stents 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 video/TV screen to a coronary artery until its tip reaches the narrowed or blocked section. A balloon mounted on a catheter is inflated to a diameter of 3mm, flattening the atheroma.
A short tube of stainless steel mesh – 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 coronary artery surgery in the UK each year, and the success rate is excellent. Around eight in 10 patients will experience immediate and lasting relief.
Condition: Heart rhythm disorders
Heart rhythm disorders (arrhythmias) are problems that affect the electrical system,or ‘wiring’ of the heart muscle. 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 the risk. These include smoking, drinking excess alcohol, leading a sedentary lifestyle, obesity, eating an unhealthy diet and too much salt.
The aim is to bring the heart rate back to a normal level and drugs such as beta- blockers and Verapamil, the calcium channel blocker, are often used. Amiodarone is used mainly for atrial fibrillation (when the heart beats quickly and irregularly). Anticoagulent drugs such as heparin and warfarin are often used to prevent clots from forming.Cardioversion is a treatment which delivers a small, controlled electrical shock to your heart to interrupt an arrhythmia so that the normal electrical pathway of your heart takes over again. An artificial pacemaker may be needed for irregular heart rhythms. A pacemaking system has a pulse generator and electrode leads. Electrical impulses are conducted through the electrode to the heart, stimulating heartbeats. An implantable cardioverter defibrillator (ICD) is a device which gives 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 another.
This is a disease of the heart muscle and there are four types – hypertrophic, arrhythmogenic right ventricular cardiomyopathy, dilated and restrictive. With this condition the muscular walls of the heart can become stretched, the heart can become larger and the heart muscle weaker, making it unable to pump well. The muscle walls can also become thicker, damaged or stiffened, which can affect
how much and how efficiently blood is pumped around the body.
What causes it? Cardiomyopathy may occur for many different reasons, including coronary heart disease, high blood pressure, viral infection, high alcohol intake and thyroid disease. It can also be caused by scarring (fibrosis) of the heart muscle. This condition can be inherited.
When symptoms aren’t controlled by medication and a person’s quality of life is greatly affected, heart transplantation may be considered. Around 300 heart transplants are carried out in the UK each year. The operations are usually performed on people with severe heart failure caused by cardiomyopathy or coronary heart disease. They can also be carried out on patients with severe abnormalities of the heart valves, congenital heart defects or an uncontrollable fast heart beat. During surgery, the heart is stopped and a machine takes over the function of the heart and lungs. The diseased heart is removed and the donor organ sewn in and connected to the main blood vessels. Between 50% and 60% of heart transplant patients are alive after 10 years.
Condition: heart attack
The heart is surrounded by three major coronary arteries that supply it with blood and oxygen. If a blood clot develops in oneof these arteries, the blood supply to that area will stop. This is known as a heart attack, or in medical terms a coronary thrombosis or myocardial infarction. Symptoms of a heart attack include severe central chest pain behind the breastbone sometimes spreading to the arms and in particular the left arm, as well as the neck and jaw. Some people start to feel sick, sweaty and breathless, too.
What causes it? A heart attack usually occurs 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 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 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 attack 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 than women. Diabetes, stress, being overweight and lack of exercise are other key risk factors.
If you haven’t already taken aspirin, one 300mg tablet of aspirin is given on arrival at the hospital. This prevents platelets (small blood cells) from sticking together around the clot blocking the artery. Thrombolysis, sometimes described as a clot-busting drug, is injected into the bloodstream to help dissolve the clot 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 you can’t receive thrombolytic medicine for medical reasons or have a sustained low blood pressure. Beta-blockers may be prescribed after a heart attack to lower blood pressure and reduce chances of another attack.
High blood pressure
Also known as hypertension, this condition is harmful to your health because, if untreated, it puts a strain on the heart and arteries, resulting in damage to delicate tissues, and other health problems. The higher your blood pressure is – that is persistently higher than the normal level of 140/85 – the greater the risk of complications such as heart attack, coronary artery disease and stroke. As there are rarely any symptoms, the only way to find out if you have high blood pressure is to check it. Lowering your blood pressure can lower your chance of a heart attack by 20%. What causes it? The condition is more common among men, but being overweight is a factor, as are drinking excess alcohol, stress, not exercising and eating too much salt.
High blood pressure can’t be cured but it can be controlled. If you have mild hypertension, changing your lifestyle can lower it. If you are fairly overweight losing just 10kg (22lb) can reduce the bottom figure of your blood pressure by as much as 20 points. High blood pressure may be treated with drugs which work to make the arteries relax and widen, thereby lowering blood pressure.
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