PROF. A.G. AHANGAR
Director, NEIGRIHMS, Shillong
The Human Heart The Human heart is made up of four chambers, two atria and two ventricles. De-oxygenated or so called impure blood returns to the right side of the heart via the venous circulation through Superior Vena Cava and Inferior Vena Cava. It is pumped into the right ventricle and then to the lungs where carbon dioxide is exchanged with oxygen. The oxygenated blood then travels back to the left side of the heart through the left atrium, into the left ventricle from where it is pumped into the aorta and systemic circulation. The pressure created in the arteries by the contraction of the left ventricle generates systolic blood pressure. After the left ventricle has fully contracted it begins to relax and
Different Heart Diseases Congenital Heart Disease
heart muscle with blood. Congenital heart diseases occur when one is born with malformations of its structures. This may be the result of the defective genes inherited from parents or adverse exposure to certain elements while still in the womb, such as some medicines or some viral infections or Radiation Exposure. Congenital heart disease is a broad term and examples are holes in the heart, abnormal valves, and abnormal heart chambers, abnormal branching or origin of blood vessels entering or arising from the Heart or abnormal communications / connections or else malposition of atria and ventricles eg. Transposition of great vessels. It is possible for one to have a birth defect and not have symptoms at all.
The symptoms of congenital heart dis- ease may include a bluish discoloration of the skin (cyanosis), fast breathing and poor feeding, Poor weight gain, getting recurrent respiratory tract infections or failure to thrive, delay in milestones in association with other chromosomal abnormalities refill with blood from the left atrium. The pressure in the systemic arteries falls whilst the ventricle refills. This reflects the diastolic blood pressure. Each Heart beat creates a thrust in the circulation that is perceived as pulse. The atrio-ventricular septum, a par- tition completely separates the two sides of the heart. Unless there is a septal defect, the two sides of the heart do not communicate directly. Blood travels from right side to left side via the lungs only after gaseous exchange. However the chambers of the heart work together in synchrony.
The two atria contract simultaneously, as do the two ventricles. The heart receives its own blood supply from the coro- nary arteries. Two major coronary ar- teries branch off from the aorta near the point where the aorta and the left ventricle meet. These arteries and their branches supply all parts of the Mild heart defects don’t necessar- ily need be treated, although regular check-ups are required. More severe heart defects usually require surgery and long-term follow up of the patient throughout adult life by a specialist. In some cases, medications may be used to relieve symptoms or stabilize the condition before and/or after surgery.
Valvular Heart Disease
A variety of diseases can lead to valvular damage and subsequent Heart failure. Rheumatic heart disease is caused by one or more attacks of rheumatic fever that damage particularly the heart valves. Rheumatic fever usually occurs in childhood, and may follow a streptococcal infection. In some cases, the infection affects the heart and may result in scarring of the valves, or weakening the heart muscle. The valves become narrow (stenosis), leaking (regurgitation) or not approximate properly (prolapse). Some connective tissue disorders or cancer may also damage heart valves. The treat- ment for heart valve disease includes surgery, besides medication, that can be performed by valve replacement or repair surgery, or minimally invasive
Hypertensive Heart Diseases Hypertension
balloon valvuloplasty when feasible. High blood pressure is the excessive amount of tension on the Vessel Walls produced by the flow of blood through our blood vessels. High blood pressure may cause many types of cardiovascular diseases, such as heart failure / stroke and kidney disease and Aneurysms Atherosclerosis . In atherosclerosis the walls of arteries become thick and stiff because of the buildup of fatty deposits.When this happens, the flow of blood is restricted. In atherosclerosis the walls of arteries become thick and stiff because of the buildup of fatty deposits.
When this happens, the flow of blood is restricted. In the arteries of the heart it is known as coronary artery disease. Atherosclerosis happens over a period of time and its consequences can be grave and include heart attack and stroke etc. It is an aging process that can be modified by our dietary habits and proper nutritional care be- sides regular physical activities and effective control of Blood Sugar and Lipid Profile.
Aneurysm
An aneurysm is a bulge or weakness in the wall of a blood vessel. Aneurysms can enlarge over a period of time and may be life threatening if these rupture. These can occur because of high bold pressure and atherosclerosis or infection or trauma. The most com- mon sites include thoracic / abdominal aorta and the arteries at the base of the brain or major limb vessels.
Ischemic Heart Disease Coronary Artery Disease
Coronary artery diseases lead to ischemic myocardium. It is caused by atherosclerosis leading to narrowing and / or blockage of the blood vessels that supply the heart made itself. It is one of the most common forms of heart disease and the leading cause of heart attacks, angina and heart failure and thromboembolism.
Angina
Blood carries oxygen and substrate for nourishment for its survival and growth of the body tissues / organs systems. Angina manifests as pain in the chest resulting from reduced blood supply to the heart muscle from Ischemia. Angina is caused by atherosclerosis, leading to the narrowing and / blockage of the blood vessels that supply blood to the heart. The typical pain of angina is felt in the left chest but it can often radiate to the left arm, shoulder or jaw. The pain is related to exertion and is relieved by rest. An angina attack is also associated with shortness of breath and sweating. If angina symptoms rapidly worsen and occur even at rest this may presage an impending heart attack (myo- cardial infarction) and one should seek medical help immediately.
Heart Attack
A heart attack (myocardial infarc- tion) occurs when a large proportion of Heart muscle gets deprived of Blood Supply. A heart attack manifests as severe central chest pain, which may also radiate to the left arm, shoulder or jaw. Severe shortness of breath, sweating and feeling of a constriction are common additional symptoms, some- times leading to unconsciousness. A heart attack need not be fatal, especially if one receives medical attention and treatment to deal with the blockage soon after the heart attack. But one is likely to be left with a dam- aged heart post heart attack.
Cardiomyopathy
Cardiomyopathy refers to diseased state of the heart muscle. Some types of cardiomyopathies are genetic, while others occur because of infection or other reasons that are less well under- stood. One of the most common types of cardiomyopathy is idiopathic di- lated cardiomyopathy, where the heart is enlarged. Other types include ischemic, loss of heart muscle; or hyper- trophic, where heart muscle is thick- ened, ultimately leading to Dilatation of the Heart with reduced Efficacy of its pumping action leading to Heart failure and its consequences.
Heart Failure
Heart failure is a chronic condition that happens when the heart muscle becomes too damaged to adequately pump the blood to the body. Although the heart still works but it is less effective as various organs / tissues do not get enough substrate and oxygen. Heart failure tends to affect older people more often and manifests as short- ness of breath, reduced exercise tolerance and swelling of the feet, recurrent chest infectious and palpitations.
A word about Stroke
A stroke occurs when the blood supply to the brain is interrupted. This can happen either when a blood vessel in the brain or neck is blocked due to a disease process in the heart or in the main arteries supplying the brain or when a blood vessels supplying the brain leaks because if rupture of an aneurysm. The brain is deprived of oxygen and substrate and it may be permanently damaged. The consequences of a stroke can include problems with speech or vision, weakness or paralysis and loss of consciousness and sphincter control even death.
Sudden Death
Sudden death occurs when there is an abrupt cessation of the heart’s ability to pump blood. This may be because of heart attack or serious abnormality of the rhythm of the Heart beat.
Pericardial Diseases
The covering that encases the heart is called the pericardium and it can be affected by a variety of conditions such as inflammation (pericarditis), fluid accumulation (pericardial effusion) and stiffness (constrictive peri- carditis). The aetiology of these condi- tions varies from idiopathic (unknown cause) to viral, bacterial infections, and trauma etc, the commonest being tuberculosis.
Tests conducted for investigating heart diseases
Blood tests: Certain enzymes are checked for evidence of heart muscle damage that would confirm a heart at- tack e.g., CK., CPK, Trop-t test etc.
Chest X-ray: shows the size and shape and contours of the heart. It can also show any fluid in the chest, which may be caused by heart disease.
ECG (electrocardiogram): An ECG gives a recording of the electrical activity of the heart. It reflects the status of the heartbeat and evidence of any insult to the heart muscle or its conduction tissue.
24 hour ECG (Holter): This test is similar to an ordinary ECG in that it records the patient’s heart rhythm over a 24 hour period (or longer if re- quested) as the patient goes or about the daily routine. The recorded heart rhythm can be analyzed in detail for any rhythm disorder etc.
Exercise related ischemic events/ Treadmill Test (TMT): This is a variation of an ECG, which records the activity of the heart as one makes it work harder, by walking and running on a treadmill, while one is closely monitored during an exercise ECG. It is used to assist in diagnosing angina and its severity, because it records changes that heart experiences due to an insufficient blood supply against in- creasing demand from exercise.
Angiography: it is used to assess damage or the extent of narrowing in the coronary arteries and status of various chambers of the heart and Major blood vessels. Under local anaesthetic, a catheter is inserted into a main artery in the groin, or the forearm, and then passed gen- tly into the heart or its blood vessels. A dye is then injected which fills the blood vessels or the chambers and an x-ray picture is taken. This picture can then be studied to assess which arteries are damaged and how severe the damage is or any abnormality of its cham- ber or major inflow / outflow vessels / com- munications.
Echocardiogram: It is an Ultrasound scan of the heart. This tells about the size of the heart, how well muscle is working, how well the valves are working and the status of its various chambers, partitions and major ves- sels, or inter chamber communications.
Thallium scan (myocardial perfusion scintigraphy):
This scan shows how well blood is reaching the heart muscles through the coronary arteries. This scan is useful when exercise test cannot be done or when specific information on the heart muscle is needed. Other complex investigations include CT Imaging, Intracardiac Dop- pler / Echocardiography and Electrophysi- ological mapping etc., depending upon the severity of the heart ailment.
Treatment / Management of Heart Diseases
Treatment / Management of a Heart Disease depend upon the type and extent of the disease or abnormality of the heart structure involved. It may range from simple Counseling to Medica- tion or sometimes Intervention or Surgery depending upon the symptom / functional capacity of an individual. Treatment in terms of medicines required may be antianginal drugs, Beta Blockers, Antihypertensive, or other After–load reducing drugs, lipid lowering drugs, besides treat- ment of comorbid states like Diabetes mellitus, Hypertension, Atherosclerosis, and it may also include cessation of smoking, alcohol consumption, Life style modifications and reduction of risk factors and so on.
Treatment focuses on lowering the risk for heart attack and stroke, and managing the symp- toms. Lifestyle changes, medicines and intervention proce- dures are used to relieve the pain and other sequelae. If angina symptoms get worse even while taking medicines, it may require procedures to improve blood flow to the heart muscle. These include angioplasty with or with- out stenting and bypass surgery, pacemaker implantation, etc. Interventions may be needed for rhythm disorders and other ailments of Heart with Pacemaker Implantations, Angioplasty or Stent Placement and other Therapeutic interventions like Device closures for various Septal Defects or Vascular intercon- nections.
Surgical Intervention may be in the form of open heart procedure like closure of Various Septal Defects, Correction of various complex abnormalities, Valve Re- pairs / Replacement or Remodel- ing procedures in myopathies or Coronary Artery Bypass Grafting (CABG) in Ischemic Heart Dis- ease, on or off – pump minimally Invasive procedures or percutaneous valve replacement in Aortic valve disease. Advanced management in terms of Stem Cell Infusion, Transmyocardial / Laser Revas- cularization, LV Assist Devices, Bridge to Heart Transplant and ultimately Heart Transplant it- self are the last resorts in severe- ly diseased, defunct Heart States. Preventive measures include proper immunization protocols during pregnancy and after birth, avoiding mutagenic drugs, antibiotic prophylaxis and genet- ic counseling besides adapting right approaches to the Life Style. Minimizing consumption of Salt, Sugar, Smoke, Alcohol and avoid- ing Stress and other such related circumstances would do a lot of human service to minimize the Heart Disease and the disability / handicap arising from the social burden under such circumstances. Physical activities and exercise to burn excess fat in our body the very vital for healthy life
The Author can be mailed @ [email protected] (This manuscript is only for general awareness of masses and not for any scientific / legal implications of any vested interests).
