Heart disease MARADHI YA MOYO

Heart disease MARADHI YA MOYO

Herbalist Dr MziziMkavu

Herbalist Dr MziziMkavu

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Coronary hWhat is heart disease?



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Coronary heart disease (CHD) is one of the commonest diseases to affect the heart. It's usually caused by atherosclerosis, a build up of fatty materials within the walls of the arteries.
Dr Jeni Worden last medically reviewed this article in January 2010.





What is CHD?

In CHD, the arteries that supply the heart with oxygen and nutrients become narrowed by atherosclerosis restricting the supply of blood and oxygen to the heart, particularly during exertion when there are more demands on the heart muscle.

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Symptoms of CHD

The main symptom is angina, caused by insufficient oxygen reaching the heart muscle because of reduced blood flow. Angina is a feeling of heaviness, tightness or pain in the middle of your chest that may extend to your arms, neck, jaw, face, back or abdomen.
The following symptoms are by no means always owing to CHD, and could be harmless or caused by other medical conditions. However, if you experience any of them it's a good idea to make an appointment to see your doctor:

  • Unusual breathlessness when doing light activity or at rest, or breathlessness that comes on suddenly
  • Palpitations - awareness of your heart beat or a feeling of having a rapid and unusually forceful heartbeat, especially if they last for several hours or recur over several days and/or cause chest pain, breathlessness or dizziness
  • Fainting - although not always a serious symptom, fainting is due to insufficient oxygen reaching the brain, so you should report it to your doctor
  • Fluid retention or puffiness (the medical term is oedema) is an abnormal accumulation of fluid in the tissues of the ankles, legs, lungs or abdomen, for example. Although a mild degree of ankle oedema may be quite normal - for example, on a hot day - it can be a sign that the heart isn't pumping as well as it should (this is known as heart failure). Fluid retention in the lungs, or pulmonary oedema, can cause intense shortness of breath, and may be life-threatening
  • Bluish-tinged fingernails or lips (known medically as cyanosis) can be the result of too little oxygen in the blood
  • Fatigue is a common symptom of heart disease, but has numerous causes, including depression. It's always worth seeing your doctor if you feel unusually tired, especially if this is combined with symptoms that can't be explained

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Causes of CHD

The most common cause is atherosclerosis, a build up of fatty materials within the walls of the arteries throughout the body, most importantly in the arteries to the tissues of the heart - the coronary arteries.
During this process, the inner lining of the arteries becomes furred with a thick, porridge-like sludge

(atheroma), consisting of fatty deposits of cholesterol, cell waste and other substances. These form raised patches on the artery wall - known as 'plaques' - that narrow the arteries, reducing the space through which blood can flow. At the same time, the blood becomes more prone to clotting. These growing plaques may block

the delivery of nutrients to the artery walls, causing the arteries throughout the circulation to lose their elasticity. In turn, this can lead to high blood pressure, which also increases the risk of CHD.


A heart attack occurs when one of the coronary arteries blocks completely. This final step usually happens when a plaque splits open for some reason, causing a blood clot to form on its surface that obstructs the flow of blood. It's not yet understood why plaques split open, but inflammation seems to play a part. When the s

Supply of oxygen and nutrients is completely blocked, the heart muscle and tissue supplied by that artery dies. Some people are particularly predisposed towards developing atherosclerosis, due to inherited genetic factors. They may have a family history of people dying at a young age from CHD. An unhealthy diet, lack of exercise, diabetes, high blood pressure and smoking all increase the risk.

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Other heart diseases

Other diseases that commonly affect the heart include:

  • Infection - bacterial infections are much rarer these days thanks to antibiotics, but can damage the valves of the heart as well as other tissues. Viral infections can damage the heart muscle leading to heart failure, or cause abnormal heart rhythms.
  • Congenital heart disease - there's a range of structural abnormalities that can develop in the heart as a baby grows in the womb. These may cause abnormal flow through the heart (for example, through a septal defect or hole in the heart) or through the rest of the circulation, and put excessive strain on the infant's heart after it's born.
  • Cardiomyopathy - this is disease of the heart muscle and may occur for many different reasons, including CHD, high blood pressure, viral infection, high alcohol intake and thyroid disease.
For many people with heart disease, there is a combination of factors that can cause problems. For example, CHD (most adults have some degree of atherosclerosis, especially if they smoke) and high blood pressure are often found together.




Disclaimer

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or

liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service

mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.source.http://www.bbc.co.uk/health/physical_health/conditions/in_depth/heart/aboutheart_index.shtml







eart disease is the biggest killer in the UK. But medical advances mean that having heart disease is no longer a death sentence and there are lots of things that you can do to reduce your risk.




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Heart conditions

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Common conditions affecting the heart.







 
Preventing heart disease

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Becoming more active, improving your diet and cutting out smoking reduces your risk of coronary heart disease.






Heart disease treatment



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Advances in medicine means that with the right treatment many people with heart disease can lead relatively normal lives.
This article was last reviewed by Gill Jenkins in July 2012

Drug management

Doctors have been treating heart disease for hundreds of years, and now modern drugs mean many people with heart disease can lead a relatively normal life. Treatments for heart disease aim to do one or more things:

  • Improve blood flow through the coronary arteries - by dilating the arteries, for example.
  • Reduce the build-up of atherosclerosis.
  • Help the heart muscle to work better, allowing the heart to act more efficiently as a pump.
  • Change the electrical control of the heart, so influencing the rhythm, for example by slowing the heart when it beats too fast, or preventing abnormal rhythms, such as atrial fibrillation.
  • Thin the blood to improve flow, stop clots from forming and prevent a heart attack.
  • Reduce the strain on the heart, for example by controlling blood pressure.

Drugs to treat heart conditions adjust the working of the heart or circulation of the blood.

There are a range of drugs doctors can use to treat heart disease. Many people will find that they're advised to take several different medicines together, depending on the nature of their heart problem and whether they have risk factors such as high blood pressure.

Most are taken orally as tablets or capsules to be swallowed, but they can also come in the form of tablets held under the tongue, aerosols or patches. Drugs can also be administered directly into a vein or a muscle.
Many heart drugs can induce minor side-effects, but most settle down in time. Your doctor and/or pharmacist

will alert you to any side-effects and what you should do about them, and you'll also find details in the information leaflet that comes with your medication. If you develop any unexpected effects, or if you're worried, contact your doctor.
Listed below are some of the commonest drugs used in heart disease.

Angiotensin-converting enzymes inhibitors ('ACE-inhibitors') and Angiotensin-II receptor antagonists ('A-II's')

These drugs, which work on the renin-angiotensin hormonal system of the kidney, are used in hypertension and cardiac failure, as well as both after a heart attack and prophylactically, to prevent cardiovascular events.

Aspirin and anti-platelet medications

These prevent blood clotting in the arteries by reducing the stickiness of blood cells called platelets, which are involved in clotting. This helps to improve blood flow in narrowed coronary arteries and reduces the risk of a blocked artery leading to a heart attack. These drugs are also used after heart bypass surgery to prevent blood clotting.

Beta blockers

These are used to prevent angina, treat high blood pressure and improve heart failure. They work by slowing the heart and also relaxing muscle in the artery walls throughout the circulation, so that the heart doesn't have

to work so hard, which also helps in heart failure. Beta blockers can lower the risk of another heart attack if you have already had one, and/or help control abnormal heart rhythms (arrhythmias). As they have a risk of side-

effects such as tiredness, they are no longer first-line medication in high blood pressure but many people have taken them for a long time and remain on them, whilst for others they may be used if the newer first line medications aren't tolerated or effective.

Calcium channel blockers

There are different types of calcium channel blockers and they have differing effects. Some relax and dilate the blood vessels and are used for treating angina, high blood pressure and heart failure, while others slow the rate at which the heart beats and are used to treat abnormal heart rhythms.

Diuretics

These drugs, often referred to as 'water tablets', may be used to control blood pressure or remove excess fluid from the body in heart failure. There are different types of diuretic and they generally act by increasing the excretion of water and sodium by the kidneys.

Nitrates

Nitrates dilate blood vessels, including the coronary arteries. This improves blood flow to the heart muscle, which helps to relieve angina. Glyceryl trinitrate (GTN) is a commonly used nitrate. It's in the tiny pills, or spray, which people put under their tongue during an angina attack but only has a short-term effect. Other long-acting nitrates may be used to create long-term arterial dilatation. Dilation of the arteries reduces the work the heart has to do to pump blood around the body, so nitrates are also helpful in heart failure.

Statins and fibrates

These drugs are used to help reduce the amount of cholesterol in the blood. High levels of cholesterol are a risk factor for heart disease. By lowering unhealthy levels of cholesterol, the risk of CHD and heart attacks is reduced.

Thrombolytic drugs v. percutaneous coronary intervention (PCI)

This group of drugs, such as reteplase or tenecteplase, radically improves the treatment of, and survival from, heart attacks. They can dissolve clots that form in a coronary artery and trigger

heart attacks if given quickly enough - within a couple of hours of onset of a heart attack. These will restore the blood flow through the artery in time to avoid permanent damage to the heart muscle. However, because the drug thins the blood it can cause brain haemorrhage (stroke) in a

significant number of patients. Recent developments in the field of emergency percutaneous coronary intervention (PCI) have meant that PCI is the preferred method. Compared with

fibrinolysis, PCI results in less reocclusion, improved left ventricular function and improved overall outcome (including reduced risk of stroke) but pre-hospital thrombolysis is indicated if the time from the initial call to arrival at hospital is likely to be over 30 minutes.
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Management of an acute heart attack

When a heart attack is suspected, it is now considered imperative to get the patient to a hospital as quickly as possible for PCI ('Primary percutaneous coronary intervention'), preferably within 90

minutes. This procedure involves the non-surgical widening of the blocked coronary artery, by means of a balloon catheter to dilate the artery and then a metallic stent is placed in the artery after dilatation to hold it open. PCI has dramatically improved survival rates after a heart attack and

reduced the risk of complications such as further heart attacks, strokes and heart failure. Antiplatelet agents are also used and stents may be either 'bare metal' or 'drug-eluting' stents (coated with drugs which affect the re-growth of cells around them.)

If the patient cannot be taken quickly to a hospital for PCI, a thrombolytic drug (e.g. Streptokinase, alteplase, reteplase or tenecteplase) should be administered along with either unfractionated heparin, or a low molecular weight heparin (e.g. enoxaparin). Thrombolytic drugs break down the

blood clot blocking the coronary artery so that the blood flow to the heart muscle can be restored and the muscle recover.

Other drugs may also be used depending on the patient, their other medical problems and also local protocols. These drugs may include aspirin or similar such as clopidogrel, or other anti-platelet drugs known as glycoprotein IIb/IIIa inhibitors given immediately to improve blood flow through the coronary arteries. Pain relief with GTN and morphine, anti-emetics, beta-blockers, diuretics, ACE-inhibitors, oxygen and other therapies may be used.

Assessment of the heart is achieved by studying an electrocardiogram (ECG: a trace of the electrical activity in the heart) and other tests, in particular a blood test that measures levels of a chemical called troponin, which is released from damaged heart muscle cells. Another test called an

echocardiogram uses ultrasound to look at the heart muscle and valves and how they move. Part of the result is described as an 'ejection fraction', a measure of how well the heart works as a pump, and whether heart failure may be a problem.

There are several different types of heart attack, usually described by the area of heart muscle that has been affected, which has important implications for what sort of complications there may be, how well the patient will recover and the treatment they should be given.

Not so long ago, a heart attack meant weeks of bed rest. Nowadays, people may spend just a few days in hospital, but a much longer process of rehabilitation is important to help the person recover fully. Additionally this process will help them deal with common problems such as depression and

reduce the risk of a second attack. Lifestyle issues such as weight management and stopping smoking, reducing alcohol intake, having a healthy diet, managing high cholesterol and taking regular exercise are vital in preventing further heart attacks.

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Cardiac procedures and surgery

Sometimes medication can't control all the symptoms of heart disease. Surgery may be needed to open (angioplasty) or replace (coronary bypass graft) the blocked arteries, repair or replace damaged valves, regulate the contraction rate with a variety of pacemakers, repair tears or dilatations in the muscle wall and, when all else has failed, heart transplants.

Coronary angioplasty

Coronary angioplasty, where a long, thin, hollow tube or catheter is passed through an incision in the groin or arm, up into the coronary arteries may be done as an emergency as in PCI, or as an elective procedure.

Atherectomy

Atherectomy uses a rotating shaver on the end of a catheter, introduced through a blood vessel in the leg or arm, which is fed through to the blocked coronary artery and cuts away the atheroma. It is not used much now for coronary arteries as there are more effective procedures, but may be used in peripheral arterial disease of the legs.

Coronary artery bypass surgery (CABG)

Coronary artery bypass surgery (CABG) is usually indicated if there are more than one or two blockages in a coronary artery and so stent insertion is not possible. During CABG a blood vessel from another part of the body, such as the leg, or the chest wall, is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.

Heart Valve replacement

Diseased heart valves can become rigid ('stenosed') or floppy ('regurgitant'), leading to poor flow through the vale or backflow. Medication may help but surgery may be required if drugs are unable to control the problem. Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue).

Cardiac pacemakers

When the electrical system of the heart becomes damaged or faulty, the contraction rate of part or all of the heart can be affected, and may be too slow, too fast or irregular or even totally stop causing sudden cardiac arrest. Medication can help but it may be necessary to put in an artificial pacemaker to make the heart beat regularly. This involves on operation to put a wire into the heart, attached to an external device and battery, to deliver electrical signals to the heart. There are also internal pacemakers which may be implanted for certain types of problem.

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Heart transplants

In the UK in 2009 there were 121 heart transplants and 5 heart and lung transplants. Heart transplants are usually carried out on people with severe heart failure caused by coronary heart disease or cardiomyopathy. They can also be carried out for patients with:

  • Severe abnormalities of the heart valves.
  • Congenital heart defects.
  • Uncontrollably fast heart rhythm.
A heart transplant may be offered for a number of reasons, when certain conditions are met:

  • The heart muscle has become weakened (cardiomyopathy).
  • The heart's blood vessels are blocked and the heart muscle is damaged.
  • Apart from heart problems, the individual is in good health.
  • Other treatments have been tried or excluded.
  • The individual is under 60 (in most cases).
  • The individual is able and willing to stick to lifestyle changes necessary after the transplant.
The average wait for a transplant once on the waiting list in the UK is six months for adults and three months for children. Unfortunately only about 70 per cent of patients on the waiting list receive a transplant.

A heart transplant operation takes about 6 hours. During the operation, the chest is opened up by cutting through the breastbone, a heart-lung bypass machine circulates and oxygenates the blood whilst the diseased heart is removed and the donor organ sewn in and connected to the main blood

vessels. The chest wall is sewn up again and the patient will usually be in intensive care on a ventilator for at least a day, and in hospital for several weeks.

After a transplant, the individual will need to take immunosuppressive drugs for the rest of their life, to stop their body rejecting the transplant, as well as other drugs to help their body fight infections. The new heart will be monitored at regular intervals for any signs of rejection.

Around 80 per cent of heart transplant patients survive for at least three years, 70 per cent for over five years and 50 per cent for over 10 years. Even so, transplant remains an 'end-of-the-line'

treatment when all else has failed and the patient is likely to die or have a poor quality of life unless it's done. Unfortunately, a shortage of donors mean that a significant number of people who are waiting for a heart transplant die before a suitable one is found.

Rest and recovery

Despite huge advances in heart surgery techniques, recovery can be slow and, in a significant number of cases, a variety of complications ranging from infection to stroke cause long-term problems. The length of time it takes to recover after any of the above procedures depends on the

type of surgery, the type of anaesthetic administered, and the age and overall state of health of the patient. It's extremely common to be easily upset and tired for the first three to six months after surgery, so it's important to get plenty of rest.

Likewise, it's extremely important to attend a cardiac rehabilitation programme to attain your optimum level of health and to learn how to modify your lifestyle to minimise the chance of future heart problems. For a small number of patients, depression is a persistent problem. Forgetfulness

is also common, but normal memory will usually return after about six months. In some cases people find they have more persistent problems with aspects of intellectual function, including

memory. This may be related to the use of the bypass pump used to circulate blood around the body while the heart is being operated on. This can cause tiny clots that block small arteries in the brain.

After any kind of heart surgery it's extremely important to pay attention to your lifestyle, watch your diet and become more active, in order to promote recovery and to help improve the health of the heart and blood vessels. A GP or cardiac nurse will be able to advise you.

Driving should be avoided for at least a month after bypass surgery. Contact the Driver and Vehicle Licensing Agency(DVLA) for details.

Rehabilitation is crucial for people who have suffered heart attacks and now have poorer health as a result. Attendance at rehabilitation programmes run by a hospital or another centre usually start f

four to six weeks after a heart attack and last for around six to eight weeks. Programmes can also be followed at home. The aim is to improve fitness and aid recovery at the same time as improving confidence and quality of life. This is done through exercise, relaxation and information on lifestyles, including diet and risk factors, and treatment.

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Disclaimer

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.






 
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