June 4th, 2014
The human heart is roughly the same size as a fist, and is situated in the middle slightly to the left side in the chest area. It is primarily made up of muscle tissue, twisted together to form a pump, and within are four chambers.
The lower left chamber has the strongest muscle, and the most muscle mass, as it’s primary role is to send your blood to the rest of your body. Quite a big job for one section of the heart. If this area of the heart is not capable of creating enough pump for blood to reach the furthest parts of the body, complications may result from the poor circulation.
The heart muscle tissue is similar to muscle that is found in the rest of the body. The only difference is that heart muscle never gets a moment rest, but must contract and relax in a constant and repetitive manner. Unlike your arm muscles, which are worked when needed, but do get a chance for relaxation. It is estimated that the heart can pump up to 5-7 litres of blood per minute. Not bad for such a small organ. There are many heart conditions that are a result of the heart’s inability to pump blood to the rest of the body, or conditions that impairs the heart from working efficiently.
One patient of mine is 50 years of age and in reasonably good health, suddenly experienced fatigue and dizziness while shopping abroad on a very cold day. There were no other symptoms accompanying this experience, such as tightness in the chest. But the onset of fatigue and dizziness was debilitating enough that he had to be escorted back to his hotel for bed rest. After a moment of rest, the fatigue and dizziness receded to some extent, but the patient was still feeling slightly weak. Upon arriving in Bangkok two days later, the patient was still plagued with spells of fatigue and dizziness, and was still unable to walk for short distances without having to rest. Needless to say, he was quite worried as he had never experienced such feelings in his healthy life. Finally, 5-6 days later the symptoms escalated to the point where the patient would find himself waking up in the middle of the night feeling short of breath.
Once the patient came to see me, I immediately learned that he did not have a history of high blood cholesterol, diabetes, or high blood pressure. Nor did any of his family have heart disease. After doing a general exam, I found that the patient’s heart rate was slightly high (104/minute), but was steady. His blood pressure measured at 110/80 mmHg, and his lungs were clear of any fluid. Furthermore, his legs were free of any swelling, which is the usual indication of heart failure in patients.
However, an echo cardiogram (an ultrasound conducted over the heart) revealed that the patient’s heart was slightly enlarged, and the strength of the heart’s contractions had decreased to 30%, while the average person’s heart contracts at 50 – 70%.
I explained to the patient that his symptoms were a result of his heart failing, caused by weak heart muscles. However, more tests would need to be done to determine the root cause of the weakening heart muscles.
Most people develop this disease (especially in the case of men) due to narrowed arteries, which decreases steady blood supply to the heart, weakening the muscles. Other causes are from vitamin B deficiency, particularly in patients that drink alcohol heavily. This condition can also occur in patients that are allergic to alcohol, yet regularly drink. One of the side effects of this is a weakening in the hearts ability to contract and pump blood. This is also known as Alcoholic Cardiomyopathy. One last possibility is that the patient has contracted a virus that affects the heart muscles with inflammation (virus myocarditis), and undermines the hearts ability to contract and pump blood.
After having injected a special dye into his arteries, to determine if there were any narrowed arteries, I found that three of his arteries were severely narrowed with plaque buildup. The patient refused to have bypass surgery as he feared complications during the procedure; I relented and performed the less invasive angioplasty surgery to widen three of his arteries.
After the procedure, I recommended that he make some further improvements in his lifestyle, such as regularly exercising, eating plenty of fresh fruits and vegetables (and staying away from fatty foods!) as well as getting plenty of relaxation time. It has now been about three months since his experience, and he has not suffered a relapse, but is steadily regaining his strength and stamina. And his heart function is returning towards normal.
Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.
Reference : http://www.rbsc.org
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