Most of the time, the heart functions very well – particularly in view of the amount of work it does. We are, however, demanding more and more from our heart and our blood vessels not perhaps directly but indirectly, through the amount we eat, drink and smoke, the pace of life and the risks to which we are exposed in the environment. It is hardly surprising, then, that things sometimes go wrong.
The chart below is intended as a quick guide to the problems that can occur. The term environment at the top of the chart means both the external environment and the internal one that exists within the body, mind and spirit
Although we cannot always be sure precisely what causes each of the conditions listed, it is generally accepted that there is an interaction between hereditary and environmental factors.
What follow is a description of each of the disorders mentioned on the flowchart. Their order follows the chart and does not bear any specific relationship to the incidence of the problem. Some of the rarer conditions are not described in any more detail in the rest of the book, but the more common problems, such as artherosclerosis, angina, high blood pressure and heart attacks are dealt with time and again in this book.
CONGENITAL HEART DISEASE
This is caused by heart malformation that are present from birth. Some of the deformities are so minor that they can be missed unless looked for. Others, such as the transposition of the great vessels, the aorta and the pulmonary arteries, or the presence of only one ventricle, are more obvious. In most crippling deformities, the deoxygenated, or used blood bypasses the lungs and continues to circulate around the body; this causes the characteristic colour of so-called blue babies.
Causes are not always clear, but certain factors during pregnancy, such as German measles, some drugs and even vitamin deficiency, have all been implicated. Some heart disorders run in families. Down syndrome babies are more likely to have malformed hearts.
Those babies with congenital heart disease who do not have a blueness to their skin can be recognised by breathlessness on feeding because they find it difficult to suck; as such children grow older, they suffer from breathlessness on exertion. Most heart defects can be corrected with surgery; fortunately, serious defects are uncommon.
Illustrated below are two of the more common congenital defects. Ventricular septal defect, or hole in the heart, is a hole in the wall, or septum, between the two lower chambers of the heart. In about 25 per cent of these cases the hole will close; if the hole is large, surgery may be required.
The second defect occur when the fetal circulatory system does not make the changes necessary for the baby to breathe on its own immediately after birth. Before birth, the fetus obtains oxygen from its mother via the placenta. To do this, the fetal heart has two bypasses, one of which, the ductus arteriosus, channels deoxygenated blood from the heart to the placenta to be oxygenated in the mother lungs, but occasionally, this does not happen. If detected early, it can be corrected with drugs; otherwise surgery may be necessary.
RHEUMATIC HEART DISEASE
Rheumatic fever is not in itself a heart disease. About 60 per cent of all cases of rheumatic fever do, however, affect the heart. It tends to run in families and chiefly affects children between five and 15 years of age.
The fever is triggered by a throat infection caused by the streptococcal bacteria. The majority of sore throats nowadays are viral, and not all streptococcal infections lead to rheumatic fever, but if your child has a sore throat or feverish illness two to three weeks after a previous sore throat, consult your doctor.
In addition to fever, joint pains and in some cases, a sore throat, rheumatic fever can cause inflammation of various areas of the heart.
Once you have had rheumatic fever, you are prone to further attacks and, if it is not treated early, it can eventually lead to scarring of one or more of the heart valves in later life. In serious cases, surgery can be carried out to repair or replace damaged valves.
Damage caused by Rheumatic Fever
The extent of the damage to the heart caused by rheumatic fever is generally proportional to the number of attacks a person has.
Rheumatic fever can cause inflammation of the heart lining , or, rarely, of the heart covering and the heart muscle itself.
Scarring of the valves
Damage to the valves caused by rheumatic fever can result in stenosis, or narrowing, of the valves, preventing them from opening properly or incompetence, when the valve does not close properly, thus allowing back flow of blood.
HIGH BLOOD PRESSURE
If the force with which the blood flows in the circulation is much greater than normal, it is called high blood pressure, also known as hypertension. This puts the entire circulatory system, including the heart and blood vessels, under considerable strain. If high blood pressure persists for a number of years, it can lead to several complications.
Atheroma in the arteries
Fatty desposits called atheroma build up along the artery walls, reducing their diameter and elesticity; it is sometimes known as hardening of the arteries.
This is the process of silting up of arteries by deposits of fatty material called atheroma. The exact cause is not known but various risk factors increase the chances of atherosclerosis. The chief ones are a family history of this condition, age, cigarette smoking, a fatty diet, high blood pressure, obesity, lack of exercise and stress.
Atherosclerosis can affect any artery in the body. The possible consequences are angina, heart attack, stroke, kidney damage or peripheral vessel disease. Atherosclerosis can largely be prevented.
Not all chest pains are due to angina, or a heart attack there can be psychosomatic causes. Anxiety causes tension and, if it is not expressed in words or actions, the pentup emotions express themselves as symptoms relating to any system in the body. When the heart is affected, it is known as neurocirculatory asthenia or psychosomatic heart disease.
The heart has long been regarded as the seat of emotion, so it is hardly surprising that anxiety and tension often have cardiovascular manifestations. The most common symptoms of this are palpitations, breathlessness and sharp stabbing pains in the region of the heart, associated with weakness, fatigue, shakiness or sweating. The symptoms can range from minor discomfort to complete invalidism.
The case history below is a good example of cardiac neurosis, although it should be remembered that not every case of non-specific chest pain is as extreme as this. Sometimes, a person is not even aware of any out-of-the ordinary stress. It is at a subconscious level but it affects his breathing and the way he feels and behaves. People with cardiac neurosis often breathe shallowly, using only the upper part of the chest.
A doctor is able to distinguish between angina and the pains of psychosomatic heart disease. In most cases, reassurance and simple psychotherapy are adequate. Exercise, learning to breathe properly and relaxation will all help to clear up this condition.
Barry was 33 years old when he first complained of stabbing chest pains and palpitations. The symptoms usually started in the evening when he was resting. He had clammy hands and perspired profusely in his armpits. He was fairly fit and could climb several flights of stairs without experiencing any symptoms. A full medical examination revealed no abnormality and Doctors were able to reassure Barry about the health of his heart.
Further probing revealed that he had a vasectomy two years ago at a private clinic a fact that he had kept secret from his wife, who was now pregnant. He continued to have minor symptoms, on and off, until his wife had the baby, after which he decided to confront her. They parted, and his symptoms did not return.
This is an interruption in the supply of blood to part of the brain which can lead to impaired function in the areas of the body controlled by that part of the brain. It can happen if a blood vessel in the brain bursts, or is blocked by a blood clot. There are two types of cerebral infarction : thrombosis, when blood coagulates and blocks a cerebral artery, and embolism, when a blood clot elsewhere in the body is released into the blood stream and wedges in a cerebral artery.
Transient ischaemic attacks are a form of mini stroke that result in slight sensory disturbance and muscle weakness lasting only a few minutes, and the patient always recovers completely within 24 hours.
Severe strokes may lead to unconsciousness, partial paralysis of one side of the body, speech problems, loss of memory, visual disturbances, and behavioural changes. Most patients will recover at least partially with a careful rehabilitation programme.
This is a blockage by a blood clot, of one of the arteries supplying blood to the brain. It results in the part of the brain supplied by that blood vessel being starved of oxygen.
CONGESTIVE HEART FAILURE
Despite its name, heart failure is not an immediately life threatening condition. It simply means that the heart cannot pump with enough force to continue efficient circulation. This may occur, for example, when the heart has to continue pumping blood into a hypertensive circulatory system. The heart eventually gets exhausted and blood does not flow through. This can result in a built-up of blood in the lungs, which in turn allows the fluid part of the blood, the plasma, to leak in the lungs, causing congested lungs and shortness of breath. It also cause fluid retention, usually resulting in swollen ankles. The heart muscle can also be weakened by infection, some degenerative charges or by a heart attack.
An aneurysm is a localised dilation, or bulging, in an artery. Aneurysms can occur anywhere, but they are most common and most troublesome when they are in a cerebral artery or in the aorta. Atherosclerosis and high blood pressure may both cause a portion of the muscular layer of the artery wall to degenerate, allowing the lining to balloon out at the point of weakness. Other causes of aneurysm are congenital weakness in the artery wall and, rarely, arterial inflammation.
The best way to prevent an aneurysm is to guard against atherosclerosis and to keep your blood pressure under control. If, however, you develop a sensation of pressure or an inexplicable lump anywhere on the body, but especially on the abdomen, and particularly if it throbs, see your doctor as soon as possible as this could indicate an aneurysm. You will probably have a simple X-ray and an ultrasound scan. Then, if necessary, the doctor will arrange for a special X-ray called an arteriograph to be taken, to help identify the exact location and extent of the problem.
If an aneurysm has already occurred, it cannot be reversed but it can sometimes be prevented from getting any bigger by a reduction in blood pressure. It can also sometimes be surgically removed, and an artificial graft inserted.
These may develop where there is a weakness in the artery wall. In one type the pressure of the circulating blood causes that part of the wall to bulge. Another type of aneurysm causes the inner and outer layers of an artery to split apart and blood to collect in between, causing the same balloon effect. Sometimes, a second split develops, which allows the blood clot back into the circulatory system.
Small aneurysms in the brain are called berry aneurysms. They are generally symptomless, but sometimes, an aneurysm causes symptoms, such as numbness or headaches, in which case diagnosis can be made by a special brain X-ray called a CT Scan. Occasionally, one of the berry aneurysms bursts;this is especially likely if blood pressure is high. A sudden severe headache is felt at the back of the head and the person may become unconscious. This is called subarachnoid haemorrhage, because the blood collects in the space beneath the arachnoid membrane covering the brain haemorrhage in younger people. A berry aneurysm can be surgically removed. Control of high blood pressure reduces the chances of one bursting.