Patient Information
Angina
Angina is a heavy, crushing pain or a tight feeling in the centre of left side of your chest. The pain can move to one or both of your arms, more often the left arm. You may also feel pain in your throat, jaw, stomach and occasionally between your shoulder blades. These symptoms usually disappear after 10 to 15 minutes with rest. Angina is the symptom of an underlying disease called coronary artery disease (CAD) and is due to build-up of narrowings in one of more of the three arteries that supply blood to the heart muscle. Angina is more likely to occur in patients with a history of diabetes, high blood pressure, high cholesterol, smoking, or a close family history of heart disease.
You may find that your angina is brought on by physical activity or emotional stress. Physical activity in cold weather or after eating may bring on an angina attack more easily. If you suffer from angina you will notice that the attacks are usually caused by particular activities or situations so you may be able to avoid those situations that you know may bring on an attack.
Tests that your doctor might arrange to investigate a possible diagnosis of angina include an ECG, a chest X-ray, blood tests, an ultrasound examination of the heart (echocardiogram), an exercise test using a treadmill, or an examination of the coronary arteries by injecting a dye into the left and right coronary arteries so any blockages show up on an X-ray. Additional non-invasive imaging to look at the heart arteries using a CT scanner may also be requested.
Treatments for angina initially are drug medication and lifestyle modification. Drug treatments are aimed at treating the symptoms as well as to lower cholesterol and blood pressure. Lifestyle modifications include an exercise programme, weight loss, dietary advice, and smoking cessation. If these measure fail that further treatment includes unblocking of the arteries with balloons and stents (coronary angioplasty) or coronary artery bypass grafting.
Heart Attack
A heart attack – also called an acute myocardial infarction – is caused by sudden and complete blockage of one of the three arteries supplying blood to the heart muscle. This usually happens when one of the arteries becomes narrowed by fatty deposits within its walls and is then blocked by a blood clot. A heart attack often happens very suddenly, without much warning. The most common symptom is a gripping or pressure-like pain behind the breastbone, often spreading to the neck, jaw and down into the arms (it is not usually brought on by exertion or relieved by rest). Patients may also experience sweating, breathlessness, loss of consciousness, and a weak pulse or one that is difficult to find.
How serious a heart attack is depends on the amount of heart muscle that is affected by the blocked artery, and on whether treatment to restore blood flow can be administered early enough. The commonest treatment for a heart attack is the intravenous administration of a drug to dissolve the clot blocking the artery. This can be given at home by trained paramedics, in an ambulance or in hospital. Increasingly patients with a heart attack are being treated with a balloon to break up the blood clot. This balloon is introduced into the blood stream using a catheter inserted either into the wrist or the groin artery under local ansesthetic.
Within a few hours of having a heart attack, your damaged heart muscle will begin to heal and gradually strengthen your heart. This is a gradual process, and over the next few weeks scar tissue will form. Although some peoples hearts will be working just as well as they were before the heart attack, others may experience angina (pain or tightness in the chest on exercise) or problems with breathlessness, tiredness or swollen ankles, which tends to happen if the heart is not pumping blood as effectively as before (heart failure).
Heart Failure
Heart failure is when the heart loses its ability to pump blood efficiently through your body. Heart failure may affect the left, right or both sides of the heart. If the left half of the heart fails (left ventricular failure), fluid will build up in the lungs due to congestion of the veins in the lungs. The commonest symptoms of this are tiredness, coughing and shortness of breath either on exercise or when lying flat. Patients may also wake up in the night with shortness of breath. If the right half of the heart fails (right ventricular failure), fluid will accumulate in the body causing weight gain and swelling of the stomach and legs.
Heart failure can be caused by many different diseases, some of which happen acutely while others are chronic, long-term conditions. These conditions include high blood pressure, diseases of the heart valves, blockages in the coronary arteries, and family-related heart muscle diseases. Sometimes, no explanation is found.
Tests that your doctor might arrange to investigate a possible diagnosis of heart failure include an ECG, a chest X-ray, blood tests, an ultrasound examination of the heart (echocardiograph), an exercise test using a treadmill, or an examination of the coronary arteries by injecting a dye into the left and right coronary arteries so any blockages show up on an X-ray. Additional non-invasive imaging to look at the heart muscle using
The mainstay of treatment for heart failure is treatment any obvious underlying cause (such as valve disease) combined with drugs. Commonly used drugs include ACE inhibitors, diuretics, beta blockers, and nitrates. Increasingly other forms of therapy such as pacemakers to resynchronise the heart and implantable defibrillators are being used.
Arrhythmias
Normal contractions of the heart are controlled by an electrical signal that begins in the heart’s natural “pacemaker”. The rate of the contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia which is a change in the rhythm of your heartbeat, either if it beats too fast or too slow. An arrhythmia can also mean that your heart beats irregularly (skips a beat or has an extra beat). Most people have felt their heart race or skip a beat (for example during stress or exercise) and such symptoms are not usually a cause for alarm. Arrhythmias that occur more often or cause symptoms may be more serious Such symptoms include palpitations or rapid thumping in your chest, feeling tired or light-headed, passing out suddenly, shortness of breath, or chest pain.
The most common cause of arrhythmias is heart disease, particularly coronary artery disease, abnormal heart valve function, heart failure, thyroid over-activity, high blood pressure and alcohol. However, arrhythmias can occur for no known reason. In most people, arrhythmias are minor and are not dangerous. A small number of people, however, have arrhythmias that are dangerous and require investigation and treatment. Arrhythmias may also be more serious if you have other heart problems.
Tests that your doctor might arrange to investigate a possible diagnosis of a cardiac arrhythmia include an ECG, a chest X-ray, blood tests, an ultrasound examination of the heart (echocardiograph), an exercise test using a treadmill, and recordings made at home of your heart rhythm over a 24-hour ( or longer) period.
Treatment depends on the type of arrhythmia you have with many arrhythmias requiring no treatment. Arrhythmias when the heart beats too slowly are usually treated with a pacemaker (an electronic device placed under the skin on the chest to maintain a regular beat). The majority of arrhythmias required treatment can be controlled with drugs such as beta blockers or calcium antagonists. Occasionally, other treatments are required and these include catheter ablation, implantation of a defibrillator or surgery to the heart.
Valvular Heart Disease
Valvular heart disease can present in many ways. Symptoms that represent significant valvular heart disease usually relate to the inability of the heart to deal with either a narrowed or regurgitant valve and include breathlessness, syncope, palpitations and lethargy. In some cases, significant valvular heart disease may be picked up at an early stage in someone who has no symptoms but has been found to have a cardiac murmur. Key tests that are used to evaluate valvular heart disease include an ECG, chest X-ray and echocardiogram. More invasive tests such as cardiac catheterisation also sometimes need to be considered. The treatment of valvular heart disease may involve major cardiac surgery (repair or replacement of the affected valve(s)) and /or drug therapy.