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Heart of the matter

July 9th, 2014


Heart of the matter

This is one of the most frequently asked questions I come across because a lot of people are concerned about heart disease. Interestingly though, many people don’t even know where the heart actually lies. Most people believe it’s between the lungs, on the left side of the chest. But in fact it lies in the middle of the chest, very slightly to the left.

The heart can be linked to “emotion” and “feelings”, which are different yet the same. Feelings are hard to control (but you can practise by meditating and keeping a conscious mind). While the actual heart is something tangible, and as with other things in this world, it is not meant to last.

The heart diseases I will talk about today concern the physical aspects of the heart, not the emotions that the heart feels. And I have divided the diseases into two groups: heart diseases and diseases related to the heart.

In order to know what the heart diseases are, we should get to know the roles that the heart plays first. The heart pumps blood out to various organs in the body. To do so, it needs help from many elements in the system.

- Pericardium, a thin double-layered sac which encloses the heart.

- Heart muscles, which are intertwined, making it possible to send blood to other organs.

- Four heart valves, which stand guard at the entry and exit points of the chambers.

- Three main coronary arteries, where clogging usually occurs that results in chest pain.

- The cardiac electrical system, which works like a battery that controls the heart rate.

Diseases related to the heart include hypertension, diabetes and high cholesterol levels, which affect heart health in some way. However, some people do not experience any symptoms in the heart area, and there might be no problem detected there as well.

Other “diseases” such as weak heart is not about the physical aspect of the heart. However, a weak feeling in the heart could be a sign that something is wrong. (Please do not come to see me for a “broken heart”. I can’t even figure out how to heal that myself!)

The most common heart diseases can be divided into seven categories:

1.Myocardial infarction, which is caused by insufficient blood supply to the heart muscles. The symptoms are chest pain in the middle, to the side, breathing problems, pain radiating to the jaws, neck, shoulders or arms, sweating, fainting and shaking heart. This disease usually comes in pair with narrowed coronary artery.

2. Congenital heart disease, which comes in many forms such as ventricular septal defect, valve stenosis (narrowing, not opened well) or regurgitation (leaking) and misplaced blood vessels. These conditions usually occur at birth but may become symptomatic in early childhood. Sometimes, though, they can be found at later stages of life. The symptoms include cyanosis (bluish lips and fingers), shortness of breath, swelling or inability to lie on your back.

3. Rheumatic diseases, which are caused by the inflammation of the heart’s valves, muscles, or pericardium. This condition typically stems from a type of bacteria that causes inflammation in the throat, which was more common in the past, but now more commonly causes valve stenosis or regurgitation, resulting in heart failure. The symptoms include shortness of breath, swelling, inability to lie on the back, or shaking heart.

4. Valve stenosis or regurgitation that are not related to rheumatic heart disease. Some patients have valve stenosis or regurgitation due to the weakness of the valve or an infection at the heart’s valves.

5. Another common type of heart disease is cardiomyopathy (weakening heart muscle), which might be a result of the death of heart muscle, viral infection or a lack of certain vitamins. The latter is more common in those who regularly drink alcohol. The symptoms generally include breathing difficulties, swelling and the inability to lie flat.

6. Hypertension-related heart disease is common in people with high blood pressure and who refuse treatment, thinking they have it under control. We used to believe that blood pressure would increase as we grew older, but in fact, blood pressure for people of all ages should not exceed 130/85 mmHg. And for diabetics, it should be lower than 120/80 mmHg.

7. Some condition or genetic can cause hypertrophic cardiomyopathy (thickening heart muscle, which in turn causes the heart to function poorly). The thickened heart muscles do not receive sufficient blood supply, so the patient might feel tired and “tight in the chest” when doing activities.

8. The last category is cardiac arrhythmia, which occurs when electrical signals travel an unusual way, causing an irregular heartbeat, whether too fast or too slow. The symptoms include shaking heart, dizziness, or fainting. It is even possible to die from this condition.

Then there are the other types of heart diseases which are less common, like heart tumour, heart infection and pericarditis (inflammation of the pericardium, the sac that surrounds the heart).

Some of you may have heard of the term “enlarged heart” _ medically known as cardiomegaly _ and noticed that it was not on the list. Determining an enlarged heart requires careful examination; an EKG and X-ray alone is not conclusive. If possible, an ultrasound (echocardiogram) is needed to accurately assess whether a patient’s heart is enlarged since this type of diagnostic test provides greater detail. The heart can become enlarged due to a number of diseases. An enlarged heart isn’t a condition in itself, but rather a symptom of an underlying problem. Still, there usually is a reason behind it.

Heart failure, too, can be caused by any of the diseases mentioned above, and like an enlarged heart, heart failure in itself is not a disease, only a condition. When the heart overworks and does not get enough rest, heart failure can occur, resulting in symptoms such as shortness of breath, inability to lie flat, swelling and pulmonary oedema (fluid accumulation in the lungs, which collects in air sacs).

Now let’s see if you can tell whether you or someone you know has a heart disease or not.

A patient of mine, who is about 50 years old, came to see me with a complaint that every time he came home late at night and saw his wife, his heart would shake and he could not breathe so well. Sometimes, even his knees would get wobbly. During that moment, his blood pressure would be around 100/70 mmHg. Can you guess what kind of heart disease he has, or whether he’s just scared of his wife?

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.


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