Heart disease: causes, symptoms, treatments

When the heart has a problem, anatomical or functional, it is good to take care of it. Here’s what you need to know.

What is it

Heart disease is any disease that affects the heart, whether structural (anatomical), or functional. They belong to the category of heart disease, for example, diseases affecting the valves of the heart (stenosis or prolapse), congenital malformations and all those diseases that can alter the functioning of the heart pump, including myocardial infarction and ischemia.

Heart diseases are divided into congenital, if present from birth, or acquired, when they arise later.

Congenital congenital ones are classified into “severe” (including cyanotizing, in which the newborn has a bluish color), “moderate” and “mild”.

Severe heart disease Require intensive and timely intervention
Moderate heart disease Require less intensive treatment or are diagnosed after the first few months of life
Mild heart disease They may not cause symptoms and often resolve spontaneously

Obese, diabetic and hypertensive people are at greater risk of developing acquired heart disease.

Sometimes the term heart disease is used as a synonym for cardiomyopathy, and vice versa. However, these are different conditions. The term cardiomyopathy refers to pathologies that affect the myocardium, that is, the heart muscle, without the presence of a malfunction of the organ. “Cardiomyopathies” refers to a broader category, which includes, among others, cardiomyopathies.

Cardiomyopathies are not uncommon, and are responsible for most deaths from cardiovascular disease. For example, hypertrophic cardiomyopathy is the most common cause of sudden deaths in young people under 35 years of age. Dilated and ischemic cardiomyopathy are the diseases for which a heart transplant is sometimes necessary.

Causes

Congenital heart disease can be genetic in origin, or be due to the mother’s exposure to harmful environmental factors, such as radiation, alcohol abuse, drugs and pollutants, or infectious diseases contracted during the first months of pregnancy. Another risk factor is if the mother suffers from diabetes mellitus.

The causes of acquired heart disease are extremely varied. They can be a consequence of bacterial or viral infections, rheumatic diseases, cancer, a previous renal failure or intoxication.

Very often they are linked to wrong lifestyles, which favor obesity, diabetes and hypertension.

Hypertensive heart disease

Hypertensive heart disease is a disease affecting the heart muscle that evolves into heart failure over time.

High blood pressure is the main cause of hypertensive heart disease. If the pressure values are not kept under control with the appropriate pharmacological therapies, the heart finds itself having to perform an overload of work to cope with which it adapts triggering a dilation process. This phenomenon leads the heart to an increase in size and thickening of the walls. The heartbeat also becomes faster, tachycardia and arrhythmias appear.

This process of modification alters the function of the heart that in the long run “wears out”. The extreme consequence is heart failure, with a lethal outcome; It is generally a gradual and progressive evolution, which takes place over years.

Blood pressure values are considered excessive when above 140 mm of mercury (mmHg) for the maximum and 90 mmHg for the minimum (see table for WHO classification).

The pressure is influenced by risk factors on which it is not possible to intervene – familiarity, genetic predisposition, advanced age – and by modifiable aspects: smoking, diet too rich in salt, obesity, atherosclerosis, diabetes and poor physical activity.

However, there are other elements that can aggravate or cause hypertensive heart disease, making the organ too rigid to pump blood properly. Beyond genetic factors and familiarity for hypertension, age and conditions very often linked to wrong lifestyles count: obesity, diabetes, smoking, alcohol abuse, diet.

In general, uncontrolled high blood pressure can lead to serious consequences over time, including heart attack, aortic aneurysm, chronic kidney disease. Hypertension is also associated with ischemic heart disease, which occurs when the oxygen supply to the heart is not sufficient, although in this case the most common cause is atherosclerosis and the consequent narrowing of the arteries.

Common symptoms

Heart disease does not always show obvious symptoms. Among the most common are:

  • dyspnoea, i.e. difficulty breathing at rest or under stress
  • “Air hunger”
  • chest pain (angina), caused by high demand from the heart as a result of poor blood supply to the coronary arteries
  • swelling in the ankles and legs
  • Palpitations.

In general, individuals with hypertensive heart disease also experience a progressive sense of asthenia and fatigue during normal daily activities.

Diagnosis

Diagnosis is based primarily on the clinical examination and patient history, with the collection of information on family and personal history, cardiovascular risk assessment and identification of risk factors that may be modified.

As for the examinations, an electrocardiogram, an echocardiography to identify structural alterations and a cardiac ultrasound with Doppler effect are performed to measure the speed of blood flow and identify dysfunctions of the valves themselves, such as narrowing or insufficiency.

Blood pressure should be monitored and the patient is prescribed, among others, specific blood tests to check renal and hepatic function.

Complications

Among the complications of the various heart diseases there may be, in addition to the evolution of heart failure – also counted among heart diseases – also pulmonary edema and embolisms. Some heart diseases, such as the so-called long QT syndrome, can cause sudden cardiac death.When systolic function is altered, the heart is unable to expel an adequate amount of blood with each contraction, for example as happens following a heart attack. Heart failure may be associated with reduced function of the left (or right) ventricle, but the most common form is the combined one, with left and right decompensation.

When the anomaly does not concern the amount of blood expelled, but that which fills the ventricular cavities, we speak instead of alteration of diastolic function. The causes in this case can be given by ischemic heart disease, alterations of the pericardium, the outer membrane that lines the heart or left ventricular hypertrophy. The latter involves increasing ventricular mass, typically as a compensation mechanism in response to an overload of work for the muscle.

Treatment

If heart disease is acquired and depends on lifestyle it is important First of all, correct bad habits, such as abolish smoking, control weight, perform activities physics. Pharmacological therapies must be established on a case-by-case basis, on the basis of basis of the specific pathology found and taking into account the factors of risk, of organ damage. and hypertension levels (see in the following table the classification of pressure levels arterial according to the World Health Organization).

Systolic (mmHg) Diastolic (mmHg)
Normal < 120 < 80
Pre-hypertension 120-139 80-89
Stage I hypertension 140-159 90-99
Stage II hypertension >160 >100
Isolated systemic hypertension >140 <90

Drug therapy is aimed above all at treating high blood pressure, and therefore reducing the workload of the heart and aims to improve the prognosis and quality of life of the patient.

Treatment makes use of various categories of drugs. Diuretics are mainly used to improve symptoms, i.e. congestion in the lower limbs, eliminating excess fluids. Other drugs used are ace inhibitors, beta-blockers and sartans. The aim is to reduce pressure and counteract the mechanism that as a result of high blood pressure determines the increase in heart rate.

In severe cases, it may be necessary to resort to surgery with angioplasty or the implantation of coronary artery bypass or a pacemaker. Treatment of congenital heart disease, where necessary, is mostly surgical.

Feeding

There is no specific diet for hypertensive heart disease, but improving nutrition is part of the lifestyle changes useful for treatment. The recommended diet in these cases should be reduced in salt and provide liquids to promote blood thinning.

In order not to aggravate the process of atherosclerosis, which is already underway in these clinical conditions, it would also be advisable to introduce low-fat foods into the diet and to favor steaming and grilling.

Preserved, pickled or canned foods, sweet and savoury snacks, sausages, cheeses and confectionery should also be avoided or at least limited in favour of fresh foods. Even coffee for its known action on heart rate, would be limited and consumed in moderation, as well as alcohol, recommended only to the extent of a glass of wine a day.

Green light instead to cooked and raw vegetables, fiber, whole grains and blue fish, for its content in omega three. As far as lifestyle is concerned, abstaining from smoking and practicing regular and constant physical activity, which includes at least a daily walk of 30 minutes, are absolutely recommended.

When to consult your doctor

In the presence of chest pain it is always good to consult a doctor. However, since heart disease, especially at the beginning, often does not give obvious symptoms, after forty years it is advisable to perform periodic routine checks.

The doctor will evaluate whether it is appropriate to proceed with more in-depth analyzes (electrocardiogram, electrocardiogram under stress, Holter, Dopple echocardiogram, etc.) to ascertain the presence of a pathology.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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