Southern Heart

This refers to narrowing of the arteries that supply blood to the heart muscle. The heart, like all other organs in the body, needs a constant supply of oxygen and energy.  Narrowed arteries are unable to keep up with the demand needed to supply the heart muscle with blood, which can cause damage to the muscle if prolonged.  The most common symptom of this problem is chest pain that occurs when you exert yourself (angina).  Typical angina chest pain is a heavy sensation in your chest associated with shortness of breath.  It sometimes radiates to your arms and can make you feel like being sick, dizzy or sweaty.  Not everybody experiences the same sensation and any one of these symptoms can represent angina.  If your GP thinks you may have angina they will refer you for an assessment to plan treatment. 

Heart Attack (Myocardial Infarction)
If an attack of angina lasts for more than 20 minutes then you may be having a heart attack.  This is where a piece of the heart muscle has been deprived of oxygen for so long that it can die resulting in permanent damage to your heart and in some cases death.  There are treatments available in hospital that can prevent heart attacks and save lives so if you have chest pain or symptoms of angina that last for more than 20 minutes you should call an ambulance and go to hospital as soon as possible

Am I likely to have cardiovascular disease?
There are several risk factors that are scientifically proven to be associated with this disease.  However even if you don’t have any of the following it could still happen to you.

You are more likely to have cardiovascular disease if you have any of the following:

Are or have been a smoker Diabetes High blood pressure High cholesterol A family history of heart disease Are older (your risk increases as you get older)  What tests am I likely to have?

Electrocardiogram (ECG)
An ECG is a recording of your heart's electrical activity. Electrode patches are attached to your skin to measure the electrical impulses given off by your heart. The result is a trace that can be read by a doctor.  It can give information of previous heart attacks or problems with the heart rhythm.

Depending on your history, examination and ECG you may go on to have some of these other tests.

Blood tests
You are likely to have blood test done before coming to clinic to check your cholesterol level and looking for evidence of diabetes.  These blood tests are done “fasting” which means you have the blood taken in the morning on an empty stomach before breakfast.

Exercise ECG
An ECG done when you are resting may be normal even when you have cardiovascular disease. During an exercise ECG the heart is made to work harder so that if there is any narrowing of the blood vessels resulting in poor blood supply it is more likely to be picked up on the tracing as your heart goes faster.  For this test you have to work harder as well which involves walking on a treadmill while your heart is monitored.  The treadmill gets faster with time but you can stop at anytime.  This test is supervised and interpreted as you go by a doctor.  This test is used to see if you have any evidence of cardiovascular disease and can give the doctor some idea as to how severe it might be so as to direct further tests and possible treatment.

Echocardiography (cardiac ultrasound)
A specially trained technician performs this test. It is a test that uses high frequency sound waves to generate pictures of your heart.  During the test, you generally lie on your back and gel is applied to your skin to increase the conductivity of the ultrasound waves. The technician then moves the small, plastic transducer over your chest. The test is painless and can take from 10 minutes to an hour.
The machine then analyses the information and develops images of your heart. These images are seen on a monitor. This is referred to as an echocardiogram.
Echocardiography can help in the diagnosis of many heart problems including cardiovascular disease, previous heart attacks, valve disorders, weakened heart muscle, and holes between heart chambers.
If doctors are looking for evidence of coronary artery disease they may perform variations of this test which include

Exercise echocardiography. This technique is used to view how your heart works under stress. It compares how your heart works when stressed by exercise versus when it is at rest. The ultrasound is conducted before you exercise and immediately after you stop. Either a stationary bicycle or standard treadmill is used.  Dobutamine stress echocardiography. If you're unable to exercise for the previous test, you might be given medication to simulate the effects of exercise. During this test, an echocardiogram is performed when you're at rest. Then medication dobutamine is then given to you via a needle into a vein in your arm.  Its effect is to make your heart work harder and faster just like with exercise.  After it has taken effect, the echocardiogram is repeated and compared.   The effects wear off very quickly.

Depending on the results of these tests you may go on to have an angiogram at a later date.

Coronary Angiogram
A cardiologist in a sterile operating theatre environment performs this test.  Most people will need to have routine tests before the procedure. These tests may require separate appointments and are usually planned the day before or the day of the procedure.
You will be asked not to eat or drink after midnight the evening before the procedure.
You are not given a general anesthetic but may have some medication to relax you if needed.  Local anesthetic is injected into an area of skin to the side of your groin or in your arm.  A needle and then tube are fed into an artery here and advanced though the blood vessels to the heart. You can’t feel this. Dye is then injected so that the heart and blood vessels can be seen on X-ray.  X-rays and measurements are then taken giving the doctors information about the state of your heart and the exact nature of any narrowed blood vessels.  This allows them to plan the best form of treatment to prevent heart attacks and control any symptoms you may have.
After the procedure you will have to lie flat for several hours to prevent bleeding.

Treatment
Consists of medication to protect the heart and its blood vessels.  These include aspirin which makes the blood less sticky and prone to clots, medication to lower your cholesterol (even if it isn’t very high this is still helpful), medication to make your heart go slower and to open the blood vessels.  You will be given a nitro lingual spray to carry with you with instructions of what to do if you have angina. 
You will be given advice on diet changes that can protect the heart as well as stop smoking programs. If you have had a heart attack you will be offered cardiac rehabilitation classes with a trained physiotherapist.
Depending on tests you may have procedures offered to surgically correct the narrowed blood vessels.   

Heart failure refers to the heart failing to pump efficiently.  There are many diseases that cause this including cardiovascular disease, high blood pressure, viral infections, alcohol, and diseases affecting the valves of the heart.  When the heart is inefficient a number of symptoms occur depending on the cause and severity of the condition.  The main symptoms are tiredness, breathlessness on exertion or lying flat, and ankle swelling.  Doctors often refer to oedema, which means fluid retention usually in your feet or lungs as a result of the heart not pumping efficiently.

Tests looking for possible causes of heart failure include:

Chest X-ray Electrocardiogram (ECG) Echocardiogram (Cardiac ultrasound) Angiogram

Treatment
You are likely to have several medications over time, started and monitored by your cardiologist and GP.  These include medication to control the amount of fluid that builds up (diuretics), medication to protect your heart and slow it down as well as to thin your blood.  You will often be referred to a dietician or given advice about restricting the amount of fluid and salt you take as this can contribute to symptoms. You can also be involved in cardiac rehabilitation programmes run by trained physiotherapists.  You will be given reading material to learn more about your disease.

Your heart rate is controlled by a complex electrical system within the heart muscle which drives it to go faster when you exert yourself and slower when you rest.  A number of conditions can affect the heart rate or rhythm.  Heart rate simply refers to how fast your heart is beating.  Heart rhythm refers to the electrical source that is driving the heart rate and whether or not it is regular or irregular.
As some types of arrhythmias can cause you to faint without warning, your doctor may restrict your driving until the condition is controlled.

Some common terms:

Sinus rhythm is the normal rhythm

Arrhythmia means abnormal rhythm.

Fibrillation means irregular rhythm or quivering of one part of the heart

Bradycardia means slow heart rate

Tachycardia means fast heart rate

Paroxysmal means the arrhythmia comes and goes

Tachycardia
The most common of these is atrial fibrillation.  This is where your heart rhythm is irregular and often too fast.  Symptoms include fatigue, palpitations (where you are aware of your heart racing or pounding), dizziness and breathlessness.
Other tachycardias include supraventricular tachycardia  (SVT)  or ventricular tachycardia (VT)  these have similar symptoms as atrial fibrillation but can also cause you to loss consciousness (faint). 

Bradycardia
The most common form of this is called heart block.  This is because messages from the electrical generator of the heart don’t get through efficiently to the rest of the heart and hence it goes very slowly or can pause.  Symptoms of the heart going to slowly include feeling tired, breathless or fainting.

Tests
As well as having the following tests to diagnose what sort of arrhythmia you have, you might be investigated for evidence of heart diseases that cause arrhythmias with echocardiography, blood tests, or tests looking for evidence of cardiovascular disease.
The first test you will have will be an electrocardiogram (ECG).  This trace of the hearts electrical activity gives the diagnosis of the source of the arrhythmia. This is often normal at rest and more extensive testing is needed to try and catch the arrhythmia especially if it is intermittent.

Ambulatory ECG

Holter monitor: This test is used to monitor your heart for rhythm abnormalities during normal activity for an uninterrupted 24-hour period. During the test, electrodes attached to your chest are connected to a portable recorder — about the size of a paperback book — that's attached to your belt or hung from a shoulder strap.

Event recorder: This is a test covering 1-2 weeks.  You wear a monitor (much smaller than a holter monitor) and if you have any symptoms such as dizziness you press a button on a recording device and it saves the recording of your heart rhythm made in the minutes leading up to and during your symptoms.  Because you can wear this for a longer period of time it has a higher rate of catching your abnormal rhythm.

Treatment
Tachycardia  Most treatments for these conditions consist of medication to stop the abnormal rhythm or make it slower if and when it occurs.  Atrial fibrillation, if you have other problems, can increase your risk of stroke so blood-thinning medication is often used as well.

Bradycardia Depending on how slow your heart goes and what symptoms you have you may be referred to the surgeons for a pacemaker.  This is a small operation where a battery powered device is placed under the skin with wires that lead to your heart and provide it with electrical stimulation to prevent it from going to slow.  You can't feel it doing this but will be aware of a small flat lump under your skin just below your collar bone.

Your heart consists of 4 chambers that receive and send blood to the lungs and body. Disorders affecting valves can either cause stenosis (a narrowing) or regurgitation (leakage after the valve has closed).  Depending on what valve is involved and how severe the damage is, it may result in symptoms of heart failure as it makes the heart pump inefficiently.
Suspicion of a heart valve problem is usually picked up by your doctor when they listen to your heart and hear a murmur.  A murmur is heard with the stethoscope and is turbulence of blood flow that occurs through a narrowed or leaky valve.  Not all heart murmurs mean serious problems but are best investigated further.

Tests
The echocardiogram is the main test to diagnose what valve is involved and how severe it is. 

Treatment
This depends on the type and severity of the valve lesion.  You may simply be monitored over years to see if anything changes. Some conditions require medication to thin the blood or treat any complicating heart problems.  You may be referred to a heart surgeon for consideration of a valve replacement or dilatation of a narrowed valve.