Angina is chest pain or discomfort that occurs when your heart isn’t receiving enough oxygen because of reduced blood flow to the heart. It is usually a symptom of coronary heart disease.
Blood enters the heart through three blood vessels. These are known as the coronary arteries and they supply the heart muscle with the blood, oxygen and nutrients it needs to keep beating. Normally, the coronary arteries deliver enough blood so that the heart muscle gets the amount of oxygen it needs to work properly. However, in coronary heart disease these arteries become narrowed reducing the amount of blood that can pass through them.
This means that blood can’t get to the heart muscle fast enough and the heart complains with pain. This pain is known as angina. It is more likely to occur during exertion (for example, walking or climbing stairs) when the heart muscle needs more blood and oxygen as it works harder.
An episode of angina is not a heart attack. Angina is due to a temporary reduction in the flow of blood to part of the heart muscle and does not damage the heart itself. A heart attack occurs when the blood supply to part of the heart is cut off and results in permanent damage to the heart muscle. However, angina does indicate an increased risk of a heart attack.
Angina is common. It affects about 1 in 50 people and there are estimated to be 1.2 million people with angina in the UK. It is more common in men than women and the likelihood of it occurring increases with age.
The heart has two upper chambers (the left and right atria,) and two lower chambers (the left and right ventricles). Atrial fibrillation is a condition in which the atria contract at a very high rate and in an irregular way.
The atria and ventricles have walls of almost pure muscle. When we talk of the heart ‘beating’, we are really referring to the sudden tightening of this muscle so that the chambers become smaller and the blood in them is squeezed out.
The control of the heartbeat starts with a small clump of muscle cells in the right atrium, called the sinoatrial node. This acts as the heart’s natural pacemaker by transporting electrical impulses to the atrioventricular node, which is located between the atria and ventricles.
The atrioventricular node determines the rate of contraction of the ventricles. It is the contraction of the left ventricle that produces the pulse rate. Atrial fibrillation occurs when there is random electrical activity within the atrian. The atrioventricular node receives more impulses than it can conduct and causes irregular contraction of the ventricles. This then causes a highly irregular pulse rate.
Cardiomyopathy refers to disease of the heart muscle. These diseases have a variety of causes, symptoms, and treatments. In cardiomyopathy, the heart muscle becomes enlarged or abnormally thick or rigid.
As cardiomyopathy progresses, the heart becomes weaker and less able to pump blood through the body. This can lead to heart failure, arrhythmias (abnormal heart rhythms), fluid buildup in the lungs or legs, ,. The weakening of the heart also can lead to other severe complications.
Cardiomyopathy can have a specific cause, such as damage to the heart from a heart attack, high blood pressure, or a viral infection. Some types of cardiomyopathy are caused by a gene mutation and run in families. In many cases, the cause is unknown. Cardiomyopathy can affect people of all ages, from babies to older adults. However, certain age groups are more likely to have certain types of cardiomyopathy. Treatment may involve medicines, surgery, non-surgical procedures, and lifestyle changes.
Some people live long, healthy lives in spite of having cardiomyopathy. Some people don’t even realise that they have the disease because they have no symptoms. In other people, the disease develops rapidly, symptoms are severe, and serious complications develop. Current treatments can reduce symptoms and complications from cardiomyopathy.
Cardiovascular diseases are diseases of the heart (cardiac muscle) or blood vessels (vasculature). However, in practice, when doctors use the term ‘cardiovascular disease’ they usually mean diseases of the heart or blood vessels that are caused by atheroma.
Patches of atheroma are like small fatty lumps that develop within the inside lining of arteries (blood vessels). Atheroma is also known as ‘atherosclerosis’ and ‘hardening of the arteries’. Patches of atheroma are often called ‘plaques’ of atheroma.
A patch of atheroma makes an artery narrower. This can reduce the blood flow through the artery. In time, patches of atheroma can become larger and thicker.
Sometimes, a patch of atheroma may develop a tiny ‘crack’ on the inside surface of the blood vessel. This may trigger a blood clot (thrombosis) to form over the patch of atheroma which may completely block the blood flow. Depending on the artery affected, a blood clot that forms on a patch of atheroma can cause a heart attack, a stroke, or other serious problems.
What are the cardiovascular diseases caused by atheroma?
Coronary Heart disease
The term ‘heart disease’, or ‘coronary heart disease’, is used for conditions caused by narrowing of one or more of the coronary (heart) arteries by atheroma. The problems this can cause include angina, heart attack, and heart failure. Heart disease is common in the UK in people over 50.
Cerebrovascular disease – stroke and TIA
Cerebrovascular disease means disease of the arteries in the brain . The problems this can cause include a stroke or a TIA (transient ischaemic attack). A stroke means that part of the brain is suddenly damaged. The common cause of a stroke is due to an artery in the brain which becomes blocked by a blood clot (thrombus). The blood clot usually forms over some atheroma. A TIA is a disorder caused by temporary lack of blood supply to a part of the brain.
Peripheral vascular disease
Peripheral vascular disease is narrowing due to atheroma that affects arteries other than arteries in the heart or brain. The arteries that take blood to the legs are the most commonly affected.
If you can prevent a build up of atheroma in the arteries, you are less likely to develop the above diseases. If you already have one of the above diseases, you may prevent or delay it from getting worse if you prevent further build-up of atheroma.
Everybody has some risk of developing atheroma. However, certain ‘risk factors’ increase the risk. Risk factors include:
- Lifestyle risk factors that can be prevented or changed:
- Lack of physical activity (a sedentary lifestyle)
- An unhealthy diet and eating too much salt
- Excess alcohol
- Treatable or partly treatable risk factors:
- Hypertension (high blood pressure)
- High cholesterol blood level
- Low levels of good cholesterol
- Kidney diseases causing diminished kidney function
- Fixed risk factors – ones that you cannot alter:
- A strong family history. This means if you have a father or brother who developed heart disease or a stroke before they were 55, or in a mother or sister before they were 65.
- Being male
- An early menopause in women
- Age. The older you become, the more likely you are to develop atheroma
- Ethnic group. For example, people who live in the UK with ancestry from India, Pakistan, Bangladesh, or Sri Lanka have an increased risk
However, if you have a fixed risk factor, you may want to make extra effort to tackle any lifestyle risk factors that can be changed.
Note: some risk factors are more ‘risky’ than others. For example, smoking probably causes a greater risk to health than obesity. Also, risk factors interact. So, if you have two or more risk factors, your health risk is much more increased than if you just have one. For example, a middle aged male smoker who does little physical activity and has a strong family history of heart disease has quite a high risk of developing a cardiovascular disease such as a heart attack or stroke before the age of 60.
Research is looking at some other factors that may be risk factors. For example, high blood levels of fibrinogen, C reactive protein, apolipoprotein B, and homocysteine are being investigated as possible risk factors.
- Lifestyle risk factors that can be prevented or changed:
Congenital Heart Disease
Congenital heart disease differs from other heart defects in that it is present from birth. At least eight in every 1,000 babies are born with a heart or circulatory condition and only about a quarter of these are detected by ultrasound scans. Sometimes, a congenital heart condition will not be found out until later in the child’s life.
Some types of congenital heart defects cause no problems to the child, while the rest can often be treated successfully. Before the 1960s, when open-heart surgery wasn’t carried out on children, many who had congenital heart disease died in infancy.
Common examples of congenital heart diseases are:
- Openings in the internal wall of the heart
- Narrowing of the main heart valves (pulmonary valve stenosis)
- Failure of a blood channel, used only before the baby is born, to close at the right time (patent ductus arteriosus)
- Narrowing of the main artery of the body (aortic stenosis)
- Blockages in the pathways between the heart and the lungs
- Abnormal connections between the chambers and vessels of the heart
Endocarditis is a rare but serious condition caused by infection of the heart lining, and heart valves.
The heart is made up of four chambers and four valves which are lined with a membrane called the endocardium. Endocarditis is caused by an infection of the endocardium, usually with bacteria. In most cases, these organisms are streptococci or staphylococci bacteria. However, in rare cases fungi or other infectious micro-organisms can cause the condition.
Endocarditis causes vegetations (clumps of bacteria and cells) to form on the heart valves, making it more difficult for the heart to function properly. It can also cause infection to spread to other parts of the body, such as the kidneys, lungs and brain. In some cases, endocarditis also causes abscesses (collections of infected fluid) to develop in the heart muscle.
The bacteria and fungi that cause endocarditis usually enter the body through everyday activities, such as brushing your teeth or eating food. However, in some cases the infection is the result of a dental or medical procedure.
Endocarditis is uncommon in people with a healthy heart. You are more at risk of developing endocarditis if you have a heart defect, such an abnormal heart valve or damaged heart tissue. Men are twice as likely to be affected by endocarditis as women. Endocarditis can occur at any age, but is more common in people aged 50 years and over.
With the appropriate treatment and care, most people with endocarditis recover
A heart attack, also known as myocardial infarction, or coronary thrombosis, is when part of the heart muscle dies because it has been starved of oxygen.
A heart attack usually occurs when a blood clot forms in one of the coronary arteries (the blood vessels that lead to the heart muscle), blocking the blood supply to the heart. A blockage can also sometimes be caused by a spasm (sudden narrowing) of a coronary artery.
A heart attack often causes severe and crushing pain in the middle of the chest. This pain may then travel from the chest to the neck, jaw, ears, arms, and wrists. The person may also be cold and clammy, and their skin may appear pale and grey in colour. If you suspect that someone is having a heart attack, or you are experiencing the symptoms of a heart attack yourself, make sure you seek medical attention immediately. The sooner the treatment is received, the more effective it will be and the greater the chance of survival.
A heart attack is much more likely to occur when your arteries have become narrowed. This usually happens over a period of many years. The arteries are often narrowed by fatty deposits which form on the artery walls. There are a number of factors which can increase the risk of these fatty deposits forming. Smoking, high blood pressure, poor diet, lack of exercise and obesity are all contributing factors.
Who is affected?
Approximately six in 1,000 men in the UK who are between 30-69 years of age have a heart attack each year. For women, the figure is much lower, at two in 1,000. Men are therefore three times more likely to suffer from a heart attack than women. A heart attack can cause serious complications, and be potentially fatal. Half of those who die, do so from cardiac arrest (when the heart stops completely) within 3-4 hours of the start of the attack.
Following a heart attack
Many people can make a full recovery following a heart attack, and most will be able to return to work and resume their daily activities, once they have completed their rehabilitation. See the ‘related articles’ section for further information about resuming daily activities following a heart attack.
As everyone who experiences a heart attack will face different difficulties and challenges, there is no set time period as to how long your recovery will take. A wide range of health professionals will provide you with all the help, support, and guidance that you need during your rehabilitation process.
Heart failure is a serious condition but it does not actually mean that your heart has failed. It means that your heart is not pumping blood around your body very efficiently. Heart failure can affect the left side of your heart, the right side, or both. The symptoms and effects on your body will depend on the side that is affected.
Symptoms of heart failure can be severe. But it can be treated, allowing you to control the effects of the condition and continue to live a normal life. Heart failure can be caused by a number of other conditions, such as high blood pressure or a heart attack. It tends to affect people over the age of 65, and is more common in men than women.
Heart block is a condition where the heart beats much more slowly than normal.. It is caused by a delay, or disruption, of the electrical signals that control the heartbeat.
A healthy heart beats between 60 and 80 times a minute. A heartbeat is when the muscles of the heart contract and push blood around the body. These muscle contractions are controlled by electrical signals that travel between the heart’s upper chambers (the atria) and lower chambers (the ventricles).
If these electrical impulses are delayed or stopped), then your heart may not beat regularly. If the electrical signals are stopped completely (complete heart block), then the heart will only beat around 40 times a minute.
Heart block reduces your heart’s efficiency in pushing blood around the body. This means that your muscles and brain may not be getting enough oxygen for them to work properly.
Types of heart block
There are three different types of heart block:
- First degree heart block (the least serious) refers to a delay in conduction of electricity from the atrium to the ventricle and often does not need treatment.
- Second degree heart block is where some of the electrical signals do not reach your heart, causing ‘drooped’ beats. It can cause dizziness and sometimes a pacemaker is needed.
- Third degree or complete heart block (the most serious) is when the electrical signals do not travel between the upper and lower chambers of your heart. It is most common in adults with heart disease, and can have serious complications, such as heart attack, if it is not treated with a pacemaker.
Heart Valve Problems
Each heart valve is a set of flaps or cusps that open or close to control the flow of blood through the heart and its chambers. The valves allow blood to flow in one direction only; if blood flows the other way, they’re forced shut.
There are four chambers in the heart and four heart valves to control blood flow between them.
- The tricuspid valve controls blood flow from the right atrium into the right ventricle.
- The pulmonary valve controls blood flow out of the right ventricle into the pulmonary artery (into the lungs).
- The mitral valve controls blood flow from the left atrium into the left ventricle.
- The aortic valve controls blood flow out of the left ventricle into the aorta (the major blood vessel leaving the heart).
If a heart valve isn’t working properly, two main problems can occur:
- Valves don’t shut properly, causing regurgitation (leakage) of blood back across the valve in the wrong direction (for example, from the aorta back into the heart).
- Valves that won’t open properly, known as stenosis of the valve, which means blood flow through the valve is restricted.
If the problem is mild, it may go unnoticed. However, it can put excessive strain on the heart, making it less effective as a pump and more likely to have an abnormal rhythm. It can also result in a back-up of pressure, causing fluid to accumulate in the lungs (pulmonary oedema) and lower leg (peripheral oedema).
Defective heart valves are also more vulnerable to infections from bacteria entering the bloodstream.
Many people with mild heart valve problems live completely normal lives with no need for treatment. However, medication or surgery may be necessary. Surgery ranges from minimally invasive procedures to open a stenosed valve (for example, by passing a tiny balloon through the blood vessels and inflating it once in place) to operations to replace a diseased valve with an artificial one.
Artificial valves may be mechanical (metal or plastic) or bioprosthetic (made from animal or human tissues). With mechanical valves, it’s often necessary to take blood-thinning drugs long-term to prevent clots forming.
Supraventricular Tachycardia (SVT)
Supraventricular tachycardia (SVT) is a heart rhythm disorder featuring episodes of abnormally fast heart rate lasting for seconds, minutes, hours or, in rare cases, days. Episodes may occur regularly or very infrequently (sometimes years apart).
The rate may be as high as 300 beats per minute, but is usually between 140 and 220. It is caused by abnormal, fast, electrical spontaneous impulses that arise in the atria, the upper chambers of the heart and override the natural pacemaker.
Attacks often come on for no obvious reason but may be triggered by exertion, emotional upset, coffee or alcohol.
In most cases, the heart is normal, although the symptoms may be uncomfortable.
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