Heart Conditions - Dr Yee Kok Meng

Cardiovascular disease is a condition affecting the blood vessel of the body eg stroke (brain), heart attack (heart), kidney, erectile dysfunction (penis), ischemic bowel (intestine) and peripheral vascular disease (lower limbs). The most common cause is inflammatory atherosclerosis, where the walls of your arteries become thickened and stiff because of the accumulation of fatty and calcium deposits. The deposits are called plaques. The inflammatory plaque is very similar to the oxidative rust of iron pipes clogging up the drainage. When this happens, the flow of blood is limited. In the arteries of the heart, it is known as coronary artery disease, in the legs, peripheral arterial disease (PAD). Many patients often confuse a heart attack with a stroke. Heart attack is caused by a blockage to the blood supply(coronary arteries) to the heart whereas stroke is a disease affecting the blood supply to the brain.

Angina is the medical terminology describing chest pains that result from reduced blood supplying oxygen to the heart (ischemia). The typical angina pain is a feeling of heaviness or tightness in the chest behind the chest bone (sternum) but it can often radiate to the left arm, shoulder or jaw. Angina pain is often related to exertion and is relieved by rest.

A heart attack (myocardial infarction) occurs when the heart’s supply of blood is occluded transiently or permanently. Lack of oxygen to the heart muscle causes tissue damage with heart muscle enzymes leaking into the bloodstream allowing doctors to detect it as raised creatinine kinase, myoglobin, and troponins. A heart attack often manifests as severe central chest pain, which may radiate to the left arm, shoulder or jaw. Severe shortness of breath, sweating, nausea and faint are also common symptoms.

A heart attack is a medical emergency and is potentially fatal, especially if there is delay in seeking medical attention. “Time is Muscle” – the immediate treatment goal is to open up the blocked artery as soon as possible. The sooner the blocked artery is opened, the damage to the heart is minimized, the greater the chances of survival!

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 or bursts. If this happens, your brain is deprived of oxygen and parts of your brain may be permanently damaged. The consequences of a stroke depend on the size of the stroke, and the region of the brain that is damaged – these may include impairment of speech or vision, limb weakness or paralysis, and in severe cases, even coma and death.

Heart failure is a condition where the heart muscles are damaged and are unable to pump blood around your body adequately. If you have heart failure your heart still works but because it is less effective your organs may not get enough blood and oxygen. It may manifest as shortness of breath (water accumulation in the lungs), reduced exercise tolerance (poor pumping efficiency) and swelling of the abdomen, scrotum, ankles. Heart failure can be caused by heart attacks, hypertension, valvular heart disease, cardiomyopathy, infections, arrthymias etc.

Peripheral arterial disease (PAD) is caused by atherosclerosis, which is the narrowing or blockage of the blood vessels in the legs. PAD often manifests as pain in the legs when walking, which is relieved by rest. If you have PAD you are at greater risk of developing gangrene in your legs.

An aneurysm is a swelling or weakness in the wall of major blood vessels. Aneurysms can enlarge over time and may be life-threatening if they rupture. They can occur because of high blood pressure or inflammation in a blood vessel wall. Aneurysms may occur in arteries in any location of the body. The most common sites include the aorta and the arteries at the base of the brain.

The function of the heart’s valves is to keep blood flowing through the heart in the right direction. But a variety of conditions can lead to valvular damage. You may be born with valvular heart disease (congenital), or the valves may be damaged by conditions such as rheumatic fever, infections, connective tissue disorders, and certain medications or radiation treatments for cancer. Valves may narrow (stenosis), leak (regurgitation or insufficiency) or not close properly (prolapse). Bacterial endocarditis (infected heart valves) is a treatable condition but may have fatal consequences if treatment is delayed. It is caused by microbe infection often causing irreversible damage to the valves.

Coronary artery disease, due to clogging of the arteries, is the leading cause of death worldwide, including Malaysia. The medical term for this process in which plaques build up over years and cause narrowing of the arteries is called “atherosclerosis”. While the exact cause of atherosclerosis remains unknown, certain traits, conditions, or habits may increase the likelihood of atherosclerosis developing and progressing. These are called cardiovascular  (CV) risk factors and a person’s chances of developing atherosclerosis increase with the number of CV risk factors they have. Whilst some CV risk factors are non-modifiable such as age, sex and family history of heart disease, many risk factors can be modified or controlled to limit the progression of atherosclerosis, and hence reduce the risk of developing heart disease. Modifiable risk factors include high Cholesterol and low-density lipoprotein (LDL – bad cholesterol) in the blood, low level of high-density lipoprotein (HDL –good cholesterol), hypertension (high blood pressure), tobacco smoking, Diabetes Mellitus, obesity, sedentary lifestyle. By targeting these risk factors, one can reduce the likelihood of developing coronary heart disease.

Coronary artery disease is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis.

This is a general term for some deformities of the heart that have been present since birth. Examples include:

• Septal defects: There is a hole between the two chambers of the heart.
• Obstruction defects: The flow of blood through various chambers of the heart is partially or totally blocked.
• Cyanotic heart disease: A defect in the heart causes a shortage of oxygen around the body.

Arrhythmia is an irregular heartbeat.

There are several ways in which a heartbeat can lose its regular rhythm. These include:

• tachycardia, when the heart beats too fast
• bradycardia, when the heart beats too slowly
• premature ventricular contractions, or additional, abnormal beats
• fibrillation, when the heartbeat is irregular

Arrhythmias occur when the electrical impulses in the heart that coordinate the heartbeat do not work properly. These make the heart beat in a way it should not, whether that be too fast, too slowly, or too erratically.

Irregular heartbeats are common, and all people experience them. They feel like a fluttering or a racing heart. However, when they change too much or occur because of a damaged or weak heart, they need to be taken more seriously and treated.

Arrhythmias can become fatal.

The heart chambers become dilated as a result of heart muscle weakness and cannot pump blood properly. The most common reason is that not enough oxygen reaches the heart muscle, due to coronary artery disease. This usually affects the left ventricle.

This is a genetic disorder in which the wall of the left ventricle thickens, making it harder for blood to be pumped out of the heart. This is the leading cause of sudden death in athletes. A parent with hypertrophic cardiomyopathy has a 50 percent chance of passing the disorder on to their children.

Also known as mitral valve regurgitation, mitral insufficiency, or mitral incompetence, this occurs when the mitral valve in the heart does not close tightly enough. This allows blood to flow back into the heart when it should leave. As a result, blood cannot move through the heart or the body efficiently.

People with this type of heart condition often feel tired and out of breath.

The valve between the left atrium and left ventricle does not fully close, it bulges upwards, or back into the atrium. In most people, the condition is not life-threatening, and no treatment is required. Some people, especially if the condition is marked by mitral regurgitation, may require treatment.

It becomes hard for the heart to pump blood from the right ventricle into the pulmonary artery because the pulmonary valve is too tight. The right ventricle has to work harder to overcome the obstruction. An infant with severe stenosis can turn blue. Older children will generally have no symptoms.

Treatment is needed if the pressure in the right ventricle is too high, and a balloon valvuloplasty or open-heart surgery may be performed to clear an obstruction.