Recognition and Management of Heart-Related Illness - An Overview

Introduction

Heart-related illnesses are the conditions that affect heart function, such as coronary heart disease, which occurs due to the build-up of cholesterol deposits on the wall of blood vessels that causes decreased blood flow, irregular heart rates, defects that are present from birth, and dysfunction in the heart valves and heart muscles. The clinical features of heart diseases can include irregular heart rate, chest pain, neck pain, fatigue, and shortness of breath. Factors such as being obese, having high cholesterol levels and blood sugar levels, smoking, being physically inactive, and having an unhealthy diet can increase the risk of developing heart disease.

How to Recognize and Manage Heart Related Illness?

Coronary Artery Disease:

This is a common type of heart-related illness due to the build-up of cholesterol deposits on the wall of blood vessels that causes decreased blood flow. This formation of plaque in the walls is called atherosclerosis. Patients with these types of diseases will not be aware until a health checkup is done regularly or until a heart attack, stroke (decreased blood flow to the brain), angina (chest pain), or heart failure occurs. The symptoms include:

• Pain, pressure, and tightness in the chest, along with discomfort.

• Pain in the jaw, neck, back, or abdomen.

• Numbness and weakness in the arms and legs.

• Shortness of breath.

• Fatigue.

The management includes lifestyle changes such as quitting habits, eating healthy, and staying physically fit. Drugs such as Aspirin (prevent blood clots), Beta-blockers (which halt the heart rate), Angiotensin-converting enzyme (ACE) inhibitors, Calcium channel blockers (decrease blood pressure), Nitroglycerin (relieve chest pain), and Ranolazine (to treat chest pain) can be given. Angioplasty (to remove a blood clot), stent placement to widen the arteries, and surgeries to treat coronary arteries, where a part of the blood vessel is attached above the damaged blood vessel to create a new path of blood flow, can be used.

Heart Arrhythmias:

It is a condition where the heartbeats are not regular, which occurs due to a problem in the heart's electrical signals. It can either be tachycardia or bradycardia, in which there is increased and decreased heart beat, respectively. The symptoms of arrhythmias include:

• Fluttering in the chest.

• Chest pain.

• Syncope (sudden loss of consciousness)

• Fatigue.

• Sweating.

• Dizziness.

• Anxiety.

• Shortness of breath.

In the case of ventricular fibrillation, a type of arrhythmia, quick management is required which involves cardiopulmonary resuscitation (CPR, mouth-to-mouth breathing, and chest compressions with a rate of 100 per minute) or an automated external defibrillator (AED) which delivers shock should be used. Medications such as beta-blockers, anti-coagulants, and calcium channel blockers are used. Therapies such as vagal maneuvers (increase vagal parasympathetic tone, exercises include such as holding breath and straining) can be included. Surgical procedures such as catheter ablation, pacemakers, implantable cardioverter-defibrillator, and coronary bypass surgery can be done.

Congenital Heart Defects:

These are the defects that occur after birth. The symptoms include:

• Swelling around the eyes, legs, or abdomen.

• Pale skin.

• Cyanosis (bluish discoloration of the skin).

• Shortness of breath.

• Poor weight gain.

• Fatigue.

• Rapid breathing.

Congenital heart disease can be treated in childhood but requires regular health checkups. Medications such as anticoagulants are given to prevent the formation of blood clots, and anti-arrhythmic medications in case of irregular heartbeat are given. Surgeries such as implantable heart devices, catheter-based treatments, and open-heart surgeries can be carried out. In case of severe problems, a heart transplant can be carried out.

Cardiomyopathy:

It is a type of disorder that occurs in the heart muscle, which causes difficulty in the pumping of the blood. It is of two types, dilated cardiomyopathy which causes narrow ventricles, and hypertrophic cardiomyopathy, in which the heart muscles become thick. The symptoms include:

• Fatigue.

• Dizziness.

• Shortness of breath.

• Irregular heartbeats.

• Swollen feet or arms.

• Chest discomfort.

• Bloated abdomen.

• Coughing (lying position).

The management includes the use of medications such as antiarrhythmic medications to slow down heart rates and anticoagulants to improve blood flow and prevent the formation of blood clots.

How to Diagnose Heart Related Illnesses?

Heart-related illnesses can be diagnosed with the help of:

• Electrocardiogram (EKG OR ECG): It is a painless and noninvasive diagnostic method that measures the heart’s electrical activity and other conditions such as irregular heart rates, blocked arteries, history of previous attacks, and efficacy of treatment such as a pacemaker.

• Echocardiogram: A type of ultrasound scan that uses high-frequency sound waves to detect the heart and its vessels.

• Stress Tests: This test shows the condition of the heart during physical activity. Stress tests involve riding a stationary bike or walking on a treadmill. This can help in assessing blood pressure, heart rate, and breathing.

• Computerized Tomography (CT) Scan: This can help detect blood clots in the lung or arteries of the heart. This can also help in detecting aortic dissection.

• Coronary Catheterization: This includes the insertion of a thin long flexible tube called a catheter into the arm or leg to evaluate the functions of the heart.

• Blood Tests: This is done to detect proteins that are involved in heart damage.

• Chest X-ray: This can help in detecting the lung problems such as collapsed lung or pneumonia (inflammation of the lung sacs). This can also show the heart's shape and its blood vessels.

• Computerized Tomography (CT) Scan: This can help detect blood clots in the lung or arteries of the heart. This can also help in detecting aortic dissection.

• Coronary Artery Calcium Scores: This helps detect the amount of calcified plaque in the arteries, because the build-up of plaque is the main cause of atherosclerotic cardiovascular disease (ASCVD), which causes acute chest pain and heart attacks.

• Cardiac Biomarkers: These are powerful diagnostic tools that can help in diagnosing, managing, and evaluating the prognosis of heart disease. Biomarkers used in the case of myocardial necrosis are; CK-MB fraction (creatine kinase-myocardial band), a type of muscle enzyme that is released in case of myocardial necrosis. This enzyme occurs within four to six hours after chest pain. Even a rise of five percent can indicate damage to the heart muscle; myoglobin, a protein that helps in transferring oxygen, these levels increase rapidly within one hour, peak in eight to ten hours, and become normal within 24 hours; and cardiac troponins, a type of muscle protein that occur in blood when there is muscle damage, this enzyme enters the blood after three to nine hours of heart damage.

• Cardiac CT Angiography: This is used in detecting high-grade stenosis with no calcium deposits in the arteries. Therefore helps in detecting noncalcified coronary stenosis.

• Myocardial Perfusion Imaging (Nuclear Stress Test): A type of test in which a radioactive tracer, a radioactive substance, is injected into the blood. A scan is taken after, which shows areas of good blood flow where the tracer is absorbed, or areas of damaged blood flow where the tracer is not absorbed, and the areas are called cold spots.

Conclusion

Heart illnesses are serious emergency situations that require rapid evaluation and treatment. Heart illness can include congenital heart disease, arrhythmias, angina, or coronary artery disease. Rapid assessment with the help of noninvasive tools such as electrocardiogram, cardiac CT angiography, myocardial perfusion imaging, and cardiac biomarkers can decrease the mortality and morbidity of the patient.