Heart disease: everything you need to know

According to the British Heart Foundation, heart and circulatory diseases cause more than a quarter of all deaths in the UK. 

Coronary heart disease is the most common type of heart and circulatory disease. It is the leading cause of death worldwide and is the single biggest cause of heart attacks. It is sometimes known as cardiovascular disease or ischemic heart disease.

Coronary heart disease occurs when there is a build-up of fatty substances that clog the arteries that supply blood to your heart — this is called atheroma. This leads to the narrowing of your arteries over time, which restricts the supply of oxygen-rich blood to your heart. Consequently, your heart weakens as it receives less oxygen and fewer nutrients than it needs to function in a healthy manner. 

Atheroma can lead to painful angina attacks, and sometimes, if pieces of the atheroma break away, they can form a blood clot that triggers a heart attack or stroke.

Other types of heart disease

Heart arrhythmia

Heart arrhythmia refers to heart rhythm problems such that you have an irregular heartbeat. This can mean your heart beats either too fast (tachycardia), too slowly (bradycardia) or irregularly (atrial fibrillation).

Congenital heart defects

Congenital defects are present from birth and therefore typically develop in the womb. Occasionally congenital heart defects can develop in children and adults due to the structure of the heart changing as you grow, revealing underlying problems with the heart. 

Types of congenital heart defects include:

• Abnormal heart valves — when valves do not open properly or leak blood
• Atresia — when one of the heart valves is missing
• Septal defects — a hole in the wall between either the upper or lower chambers of the heart

Congenital heart problems can go undetected for a number of years as they often don’t cause noticeable symptoms.

Cardiomyopathy

This is when the walls of the heart’s chambers thicken, enlarge, stretch or become stiff. This affects the heart’s ability to pump oxygenated blood around your body. Cardiomyopathy is most common in children and young people and is typically inherited.

There are three main types of cardiomyopathy:

Dilated cardiomyopathy

This is the most common type of cardiomyopathy affecting people aged 20-60 years old. It causes the heart chambers to become enlarged (dilated), specifically the lower left chamber (left ventricle) which widens with its walls becoming thinner. This prevents the heart from pumping blood properly.

Hypertrophic cardiomyopathy

This type of cardiomyopathy is usually inherited and develops over time due to natural ageing or high blood pressure. It causes the walls of the heart to thicken, making it harder for the heart to pump blood. There are often little to no symptoms as hypertrophic cardiomyopathy develops.

Restrictive cardiomyopathy

This is the least common type of cardiomyopathy, which makes the muscles in the heart become rigid. It can be caused by a number of different diseases including connective tissue disorders.

What are the risk factors for heart disease?

There are many different causes of heart disease depending on the type of heart disease you have. However, general risk factors include:

• Ageing
• A family history of heart disease 
• Drinking excess alcohol or caffeine, or smoking — you can reduce your risk by quitting smoking and reducing alcohol and caffeine consumption
• High cholesterol or being overweight — a healthy diet and regular exercise can help decrease your risk
• High blood pressure — this can damage your blood vessels and can be reduced through exercise, reducing stress and following a healthy, low-salt diet
• Stress — managing stress levels and getting plenty of sleep can help mitigate this risk factor

While men are more likely to develop cardiovascular disease, the risk increases in women after menopause. Heart disease can also develop if:

•  Part of your heart has been damaged
• There is a problem with the blood vessels surrounding your heart
• You have diabetes
• You have valvular heart disease — you can be born with valvular disease or your valves can be damaged as a result of having rheumatic fever, infections or connective tissue disorders 
• Your heart receives a low supply of oxygen and nutrients
• You had preeclampsia during pregnancy  

Managing any existing health conditions can help reduce your risk of developing heart disease.

What are the symptoms?

There are many types of heart disease; some have no symptoms and symptoms also differ between the different types. You may notice:

• Angina or chest pain
• Breathlessness or fainting 
• Fatigue
• Irregular heartbeat
• Pressure on your chest during physical exertion
•  Swelling due to fluid retention 

If a child has a congenital heart defect, they may display symptoms such as an inability to exercise and cyanosis (a blue tinge to their skin).

Heart attack symptoms

If you experience any of the symptoms below, call 999 immediately as these could be symptoms of a heart attack, which is a life-threatening condition: 

• Chest pain that lasts more than 15 minutes and spreads to your arms, neck, jaw or back
• Excessive sweating
• Nausea and/or vomiting
• Shortness of breath
• Your chest feels very heavy or tight

How is coronary heart disease diagnosed?

In order to diagnose coronary heart disease, your doctor will perform a physical examination and ask you about your medical history, your family’s history of heart disease as well as questions about your diet and lifestyle. 

Your doctor may also order a blood test and a cholesterol test. Depending on the results from these tests, you may have:

• An echocardiogram — this is a type of ultrasound scan that looks at the structures of your heart 
• Cardiac CT scan or MRI scan — this provides a detailed view of your heart 
• Chest X-ray — to check for lung conditions 
• Coronary angiogram — this shows your heart’s function on a series of X-rays
• Electrocardiogram (ECG) — this measures your heart’s rhythm
• Radionuclide tests to see the structure of your heart

You may also be referred to a doctor who specialises in treating the heart and blood vessels (cardiologist).

What are the treatment options?

Lifestyle choices

If you have coronary heart disease, you can reduce your risk of having a stroke by eating a healthy diet, exercising for at least 30 minutes every day five times a week, quitting smoking and losing any excess weight.

Surgery

Your doctor may suggest surgery to treat coronary heart disease. The type of surgery will depend on the type of coronary heart disease that you have but could be one of the following:

• Bariatric surgery — weight loss surgery to reduce your weight if you are overweight or obese
•  Coronary artery bypass graft — also known as a heart bypass; this surgery may be recommended if you have a more serious blockage and uses an artery from another part of your body to redirect the blood flow
• Coronary angioplasty — this removes the atheroma using a small wire that has a balloon attached at the end of it; it is fed into the artery and a stent is sometimes also inserted into the artery to hold it open
•  Device implantation — this is where a pacemaker or similar device is inserted in order to regulate your heartbeat and support blood flow 
• Valve replacement or repair — a surgeon will repair or replace a valve that is not functioning properly

Medication

Medications can help keep your symptoms under control. There are several different types available, including:

• Antiplatelets — these reduce clotting
• Beta-blockers, nitrates, calcium channel blockers and other medicines to regulate your heart rate
•  Statins — these lower your cholesterol

Your medicine may be in tablet or capsule form, which will need to be swallowed or dissolved in water. Alternatively, your medicine may come as an aerosol that you spray under your tongue or a self-adhesive patch, which is placed on your skin and worn for a period of time. 

Regardless of what medication you are prescribed, it’s important to know what you’re taking and understand what side effects it can cause. Speak to your doctor about why your medication has been prescribed, what the potential benefits are and also the risks it carries and what you should do if you notice any side effects. 

Ask your doctor about when and how to take your medication, and make sure your doctor is aware of all of the other medications you’re taking, including over-the-counter medicines and supplements. 

If you experience severe side effects from your medication, call 999.