Overview of the Heart

- Systemic Circulation: The left atrium receives oxygen rich blood from the lungs and distributes to the other parts of the body by the left ventricle. Blood carries oxygen and nutrients to cells and tissues throughout the body prior to re-entering the right atrium.

- Pulmonary Circulation: Deoxygenated blood from the body flows into the right atrium and is pumped to the lungs by the right ventricle. Within the lungs, blood takes in oxygen and releases carbon dioxide prior to its return to the left atrium.

Valve Function:The heart contains valves that ensure blood flows in the correct direction. The atrioventricular (AV) valves serve to partition the atrial chambers and ventricular chambers, while the semilunar valves separate the ventricles from the arteries. These valves open and close in coordination with the heart's contractions to prevent backflow of blood.

Regulation of Blood Pressure:The heart regulates blood pressure by adjusting the force and rate of its contractions. Factors such as hormonal signals, nervous system input, and changes in blood volume help maintain blood pressure within a normal range.

Oxygenation and Deoxygenation:The heart facilitates the exchange of oxygen and carbon dioxide by pumping oxygen-rich blood to the body's tissues and returning deoxygenated blood to the lungs for reoxygenation.

Supporting Circulatory System:The heart works in conjunction with blood vessels, including arteries, veins, and capillaries, to maintain circulation.

What are some of the common heart disorders?

There are several common heart diseases that affect millions of people worldwide. Some of these heart problems include:

Coronary Artery Disease or CAD:

This condition arises when plaque accumulation or a condition like atherosclerosis narrows or obstructs the coronary arteries. This diminishes blood circulation to the heart muscle, resulting in symptoms like shortness of breath, angina or chest pain and even heart attack in severe cases

Heart Failure: Heart failure arises when the heart fails to effectively pump blood to satisfy the body's requirements. This can result from conditions such as coronary artery disease, high blood pressure or cardiomyopathy (damage to the heart muscle). Signs and Symptoms of heart failure include dyspnea or shortness of breath, edema (swelling) in the legs and abdomen and fatigue.

Heart attack: A heart attack results from a complete or substantial blockage of a coronary artery by a blood clot. This cuts off blood flow to a part of the heart muscle, damaging or destroying tissue.

Arrhythmia: It is an anomaly or deviation from the normal heart rhythm. There are many different types of arrhythmias. Some types of arrhythmia are harmless and others can be serious. Examples of arrhythmia include atrial fibrillation, ventricular tachycardia and atrial flutter. These irregular cardiac rhythms can heighten the risk of significant complications including sudden cardiac arrest or stroke.

- Tachycardia is a type of arrhythmia. It refers to a rapid heart rate, typically above 100 beats per minute. It can be caused by factors such as stress, exercise, caffeine or certain medications. Persistent tachycardia may indicate underlying heart conditions like atrial fibrillation or ventricular tachycardia. Symptoms of tachycardia may include palpitations, dizziness, shortness of breath, or chest discomfort.

- Bradycardia is characterized by a slower than normal heart rate, typically under 60 beats a minute. It can be caused by factors such as aging, certain medications, or conditions like heart block. Bradycardia may lead to symptoms such as fatigue, dizziness, fainting, or shortness of breath. Severe bradycardia can deprive the body of adequate blood flow and oxygen, potentially leading to complications.

Valvular Heart Disease: When one or more of the heart's valves become damaged or diseased, valvular heart disease occurs. This can lead to the reversal of blood flow within the heart or inefficient blood circulation through it resulting in conditions such as mitral valve prolapse, aortic stenosis or mitral regurgitation. This condition causes symptoms such as chest pain, fatigue and shortness of breath.

Hypertension or High Blood Pressure: High BP is a condition where the force of blood against the artery walls is consistently too high, resulting in complications including stroke, heart disease, kidney failure and vision problems (if left untreated).

According to current guidelines, hypertension is generally defined as:

- In general, hypertension is identified by a systolic blood pressure reading of 130 mmHg or higher. Systolic blood pressure represents the pressure when your heart contracts and pumps blood out.

- A diastolic blood pressure of 80 mmHg or higher. Diastolic blood pressure represents the pressure when your heart relaxes between beats.

Hypertension is often labeled as the silent killer due to its tendency not to manifest any obvious symptoms during its initial phases. Hence, it's imperative to undergo regular blood pressure assessments, even if you are feeling well.

Congenital Heart Defects: Congenital heart defects are structural abnormalities present at birth. These can range from simple defects with no symptoms to complex conditions requiring surgical intervention. Common Instances of congenital heart defects are ventricular septal defect (VSD), tetralogy of Fallot and Atrial septal defect (ASD)

Cardiomyopathy: Cardiomyopathy is an ailment of the heart muscle that alters its structure and function. It can be caused by various factors including genetics, infections and certain medications. Dilated cardiomyopathy, restrictive cardiomyopathy and hypertrophic cardiomyopathy are among the common types of cardiomyopathy.

Peripheral Artery Disease (PAD): This heart problem occurs when there is a narrowing or blockage of the arteries in the arms or legs, reducing blood flow to these areas.Peripheral artery disease symptoms may involve cramping, weakness and leg pain especially during physical exertion.

Atherosclerosis: It is also often referred to as hardening of the arteries and is a progressive condition where fatty deposits or plaque build up inside the walls of your arteries. This buildup narrows the arteries thereby restricting blood flow to vital organs especially the heart, brain, and legs.

Endocarditis: It is an inflammation of the inner lining of the heart, called the endocardium. It usually involves the heart valves as well

Myocarditis: This heart disease occurs when the heart muscle or myocardium is inflamed. This inflammation can weaken the heart and hinder its ability to pump blood effectively.

Pericarditis: It is the inflammation of the pericardium, the sac-like membrane that surrounds and protects your heart. This inflammation can cause sharp chest pain that may worsen with breathing or lying down.

What are the symptoms of heart problems?

Heart problems can manifest with a variety of symptoms, depending on the specific condition and its severity. Some common heart problems symptoms include:

- Chest pain and discomfort: It may feel like pressure, tightness, squeezing, or burning in the chest. The pain may radiate to the arms, back, neck, jaw or stomach. Chest pain may occur during physical activity, emotional stress or at rest.

- Shortness of Breath: Difficulty breathing or shortness of breath, especially with exertion or when lying flat, can be a sign of heart failure, coronary artery disease, or other heart conditions.

- Palpitations: Sensations of rapid, fluttering, or irregular heartbeats may indicate arrhythmias, such as atrial fibrillation or ventricular tachycardia.

- Fatigue: Persistent fatigue or weakness, especially if it's out of proportion to exertion or doesn't improve with rest can be a symptom of heart failure or other heart conditions.

- Dizziness or Lightheadedness: Feeling dizzy, lightheaded or fainting (syncope) may occur due to abnormal heart rhythms

- Swelling (edema) in the legs, ankles, feet, or abdomen may occur due to fluid buildup caused by heart failure.

- Nausea or Indigestion: Some people may experience nausea, indigestion or abdominal discomfort as a symptom of heart problems, especially in women.

- Cold Sweats: Profuse sweating (especially cold sweats) may occur during a heart attack or due to other heart-related issues.

- Unexplained Weight Gain: Sudden or unexplained weight gain may occur due to fluid retention caused by heart failure.

- Cough: A persistent cough that won't go away, especially if accompanied by shortness of breath, could be related to heart problems.

If you experience any of these heart disease symptoms, especially chest pain, shortness of breath or sudden changes in your heart rhythm please seek medical attention immediately. Early detection and timely medical intervention play a pivotal role in effectively managing heart disease.

What are the causes of heart problems?

Heart problems can arise from various factors affecting the heart's function or the blood vessels supplying it. Here's a breakdown of some common causes:

- High Blood Pressure or Hypertension

- High Cholesterol or High Levels of LDL

- Diabetes

- Smoking

- Chronic Stress

- Certain Medical Conditions like sleep apnea and some autoimmune diseases

- Sedentary Lifestyle and physical inactivity

- Unhealthy dietary choices like eating processed and fatty food or junk food

- Obesity

- Coronary Artery Disease (CAD)

How do you diagnose heart disease?

Diagnosing heart disease typically involves a multifaceted and comprehensive approach which includes reviewing a patient’s medical history and familial heart disease history, conducting a physical examination and administering several diagnostic tests.

Doctors or cardiologists will also enquire about any symptoms linked with cardiac issues that you may be experiencing including dyspnea or shortness of breath, unusual fatigue and chest pain or angina.

A physical exam may involve checking your blood pressure, heart rate and listening to your heart for abnormal sounds.

Cardiac markers are natural substances in the body that are evaluated to gauge heart function. They are released into the bloodstream as a response to heart muscle damage or strain. These markers play a vital role in the timely detection or anticipation of cardiac conditions, aiding in diagnosis, risk evaluation, and management of acute coronary syndrome (ACS).

Common medical tests to diagnose heart conditions

Several medical tests are commonly used to diagnose various heart conditions. These are tests for checking heart health, evaluating the structure and function of the heart, assessing blood flow and identifying abnormalities or signs of disease. Some common medical tests used in the diagnosis of heart conditions include:

Non-invasive tests:

Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart. It can detect abnormal heart rhythms (arrhythmias), signs of heart enlargement and evidence of heart attacks

Echocardiogram or ultrasound: An echocardiogram uses ultrasound waves to create images of the heart's structure and function. It can assess the ability of the heart to pump blood, integrity of valves and chambers of the heart, as well as detect abnormalities such as congenital heart defects or heart muscle diseases.

Stress Test: A stress test evaluates how the heart performs during physical activity. It may involve walking on a treadmill or using medications to simulate exercise if the patient is unable to exercise. Stress tests typically aid in the diagnosis of CAD or coronary artery disease, assessment of exercise capacity, and evaluation of heart rhythm responses to exertion.

Holter Monitor: Patients wear a Holter monitor for 24 to 48 hours to continuously record the heart's electrical activity using a portable device. It can detect abnormal heart rhythms that may occur intermittently which may be missed during an ECG and help diagnose arrhythmias.

Cardiac MRI (Magnetic Resonance Imaging): Utilizing powerful magnets and radio waves, cardiac MRI generates intricate visuals of the heart's structure and function. It can provide information about heart muscle damage, valve function, blood flow and detect abnormalities such as tumors or inflammation.

CT Coronary Angiography: This non-invasive imaging technique utilizes computed tomography (CT) technology to evaluate blood flow and generate intricate images of the coronary arteries. It can identify narrowing of arteries and blockages or detect other abnormalities suggestive of CAD or coronary artery disease.

Minimally invasive tests:

Blood Tests: Cardiac markers are compounds discharged into the bloodstream in response to heart damage or strain. They serve in the diagnosis and tracking of different heart ailments, especially myocardial infarction (heart attack). Below is a compilation of frequently assessed cardiac markers:

- Troponin: Troponin I and Troponin T represent the most sensitive and specific indicators of myocardial injury. Their release occurs upon damage to heart muscle cells (myocytes). Troponin levels escalate shortly after myocardial damage and persist at elevated levels for several days.

- Creatine Kinase (CK): CK is an enzyme present in the heart, brain, and skeletal muscles. There exist three CK isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB serves specifically as an indicator of myocardial damage.

- CK-MB: Creatine Kinase-MB is a cardiac-specific form of CK. Increased levels of CK- MB in the bloodstream are indicative of myocardial damage, particularly in the context of acute coronary syndrome (ACS) or myocardial infarction (MI).

- Myoglobin: Myoglobin is a protein present in cardiac and skeletal muscle. It serves as an early indicator of myocardial injury, although it is less specific compared to troponin. Elevated levels of myoglobin can be detected in the blood within 1-3 hours following myocardial injury.

- LDH or Lactate Dehydrogenase: LDH is an enzyme distributed in various body tissues, including the heart. Elevated LDH levels may suggest myocardial damage, but its specificity and sensitivity are lower compared to troponin and CK-MB.

- BNP (B-type Natriuretic Peptide): BNP is a hormone released by the heart ventricles in response to heightened wall stress, such as in heart failure. Elevated BNP levels signify heart failure and can aid in diagnosis, risk assessment, and prognosis.

- CRP or C-Reactive Protein: C Reactive Protein serves as an inflammation indicator. Increased CRP levels could suggest inflammation in the heart muscle (myocarditis) or inflammation within the coronary arteries (atherosclerosis).

- NT-proBNP or N-terminal pro B-type Natriuretic Peptide: Like BNP, NT-proBNP is discharged by the heart ventricles due to elevated wall stress. It serves as an indicator for heart failure and offers prognostic insights.

These indicators play a pivotal role in diagnosing and treating diverse cardiac conditions and are frequently assessed together to offer a thorough evaluation of cardiac well-being.

Cardiac Catheterization or Angiography: This invasive procedure involves inserting a thin tube (catheter) into a blood vessel and guiding it to the heart. Contrast dye is injected into the coronary arteries to visualize blood flow and identify blockages or narrowing that may indicate coronary artery disease.

What is the best treatment for heart disease?

The best treatment for heart disease depends on the specific type and severity of the condition, as well as individual factors such as age, overall health, and medical history. However, some common treatment approaches for heart disease include:

Lifestyle Changes: Adopting a healthy lifestyle can significantly improve heart health. This includes maintaining a balanced diet, engaging in regular physical activity, quitting smoking, managing stress, and maintaining a healthy weight. Embracing a heart-conscious diet that limits saturated fat, sodium and cholesterol intake along with effectively managing stress through relaxation techniques or counseling, can boost your heart health and significantly lower the likelihood of future cardiac events.

Medications: Different medications might be recommended to address cardiac issues based on the particular condition. Common medications for heart problems include:

- Cholesterol lowering drugs or statins: They reduce heart disease risk by lowering LDL or bad cholesterol which can clog arteries and restrict blood flow to the heart

- Medications aimed at lowering blood pressure, antiarrhythmics or medications for regulating heart rhythm and antiplatelet drugs

- Blood thinners: These medications reduce the risk of clots forming in arteries, which can lead to heart attacks and strokes.

- Diuretics:They are also referred to as water pills. Fluid accumulation in the lungs and other body tissues can occur as a consequence of heart failure. Diuretics help the kidneys remove excess fluid through urination, easing strain on the heart and improving breathing. Moreover, diuretics have the ability to reduce blood pressure by decreasing the volume of fluid present in blood vessels, thus easing the heart's blood-pumping activity.

- Beta blockers: These medicines are used to slow heart rate and reduce blood pressure, easing strain on the heart in angina and heart failure.

- Calcium channel blockers: These medicines help reduce blood pressure by relaxing blood vessels or arterial wall muscles and improving blood flow to the heart.

- Nitrates: They relax blood vessels thereby improving blood flow to the heart and reducing chest pain or angina.

- Angiotensin-2 receptor blockers or ARBs: They also lower BP by blocking Angiotensin-2 hormone and improve blood flow to the heart, potentially reducing angina.

- Angiotensin-converting enzyme or ACE inhibitors: They reduce blood pressure and prevent kidney damage (especially in patients with diabetes) by lowering the quantity of Angiotensin-2, a hormone which is primarily responsible for narrowing of blood vessels

Surgical Procedures: In some cases, minimally invasive procedures or surgeries may be necessary. These could involve:

- Angioplasty (PTCA) and stenting are performed to open blocked coronary arteries. It's used for both planned procedures to address angina or chest pain and emergency treatment during heart attacks. An angiogram (X-ray) checks if you're a candidate. A tiny balloon is inserted to open the blockage, allowing better blood flow. Typically, a metal stent (tube) is placed to keep the artery open. Some stents even release medication to prevent future narrowing. Angioplasty is also referred to as percutaneous coronary intervention (PCI) or balloon angioplasty

- Coronary artery bypass grafting (CABG): It is performed to reroute blood flow around blocked arteries. A coronary angiogram can reveal if you need bypass surgery. An off pump coronary artery bypass or OPCAB is a type of CABG that creates a detour for blocked coronary arteries using a grafted blood vessel, allowing blood to flow around the blockage. This procedure avoids using a heart-lung machine by keeping the heart beating during surgery.

- Valve repair or replacement procedures are done to address or correct malfunctioning heart valves.

- Pacemaker or implantable cardioverter-defibrillator (ICD) implantation is done to regulate heart rhythm

- Cardiac resynchronization therapy (CRT): This is a treatment option for individuals with heart failure, particularly those with a condition known as dyssynchrony, where the heart's chambers do not beat in sync. CRT involves the implantation of a special type of pacemaker, called a biventricular pacemaker, or a combination device that includes both a pacemaker and a defibrillator (CRT-D).

In very rare cases, when the heart is severely damaged or If none of the other options work out a heart transplant may be needed.

Apart from this regular monitoring and follow-up care with doctors or cardiologists are essential for managing heart disease effectively. This may include routine check-ups, laboratory tests and imaging studies to monitor disease progression and treatment effectiveness.

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Frequently Asked Questions

1. What are the risk factors for heart disease?

Ans - Risk factors for heart disease include (but aren’t limited to):

- high blood pressure or high BP

- high cholesterol

- smoking

- obesity

- diabetes

- lack of physical activity

- unhealthy diet

- excessive alcohol consumption

- family history of heart disease.

2. What is a heart attack and what are its symptoms?

Ans - A heart attack occurs when blood flow to the heart is blocked or affected significantly usually by a clot. Heart attack or heart failure symptoms include (but aren’t limited to):

- chest pain, tightness or discomfort

- shortness of breath

- Nausea

- Lightheadedness

- discomfort in other areas of the upper body such as the arms, back, neck, jaw or stomach.

It is important to seek medical attention right away if you experience one or more of these aforementioned signs of heart failure.

3. What is cholesterol and how does it affect heart health?

Ans- Cholesterol is a waxy or fatty substance found in your blood. High cholesterol is one of the common causes of heart diseases. High levels of LDL (Low Density Lipoprotein) cholesterol) or bad cholesterol can lead to plaque buildup in your arteries, causing heart disease. HDL (High Density Lipoprotein) or good cholesterol helps remove LDL cholesterol.

4. How often should I have my heart checked by a healthcare professional?

Ans - Generally, yearly preventive checkups to assess heart health are recommended for adults. However, the frequency of heart checkups depends on your age, overall health condition, medical history and risk factors. Talk to your doctor or cardiologist to get a personalized recommendation.

5. What are the warning signs of a stroke?

Ans - Warning signs of a stroke include but aren’t limited to:

- Sudden numbness or weakness in the face, arm or leg (especially on one side of the body)

- Trouble speaking or understanding

- Trouble seeing in one or both eyes

- Difficulty walking

- Loss of balance or coordination

- Severe and sudden unexplained headache

- Confusion

- Dizziness

If you experience one or more of these aforementioned signs of stroke then go to a hospital immediately to seek medical attention.

6. Who should have regular Heart-check ups?

Ans - Regular heart check-ups are recommended for individuals who:

• Have a family history of heart disease
• Smoke or consume alcohol
• Are aged over 40
• Are overweight
• Have a history of heart issues
• Experience high levels of stress in their daily lives