AOPA receives numerous questions about matters of the heart and I was asked to bring some focus to this topic. I assume they were referring to medical rather than romantic issues as I would never dare to tackle that potentially thorny issue. Of course, there is a good reason why we get so many calls on this topic—heart disease is common and serious.
To a physician “heart disease” refers to numerous problems; most non-medical types think of heart attacks and heart disease as synonymous, but this is far from true. To clear things up, I will classify heart disease. The first distinction is whether the issue was there from birth, so-called congenital heart disease (CHD), most commonly structural issues where there is either a hole where there shouldn’t be or a blood vessel is out of position. The right side of the heart pumps blood to the lungs where it picks up oxygen and dumps carbon dioxide. This newly invigorated blood returns to the left side of the heart and is pumped around the body. And all this happens around 70 times a minute. If right-sided, oxygen-depleted blood gets into the left-sided circulation, the patient can appear blue and be short of breath, weak, and at risk of multiple problems. Many congenital defects are picked up either soon after birth or in childhood—a murmur might be heard when a doctor places a stethoscope over the chest. Such sounds are the manifestation of turbulent flow; think of your leading edge close to the stall or coated with ice. Not good on airplanes, not good in your heart. There has been a growing body of evidence that some cases of migraine may be associated with one particular form of CHD, “patent foramen ovale” or hole-in-the-heart. So if you have episodic headaches consider this possibility.
Heart disease that is acquired can be split up into groups:
Coronary artery disease: The blood vessels supplying oxygenated blood to the heart muscle become narrowed and the restriction of flow causes chest pain (angina) and can lead to areas of heart muscle becoming so starved of blood that cells die—we call this a myocardial infarction, medical speak for heart attack.
Valve disease: The two sides of the heart are further divided into smaller left and right atria, and the more muscular left and right ventricles. These chambers are separated one from another by valves that allow blood to only flow one way, from atria into ventricles. The one on the right is called the tricuspid valve, so named because it has three leaflets. The left-side valve is called the mitral or bicuspid (two leaflets). Additionally, when blood leaves the right ventricle en route to the lungs, it passes through the pulmonary valve and blood leaving the left ventricle for all stations around the body exits via the aortic valve. If one of these valves becomes narrowed, or stenotic, blood cannot flow smoothly causing a range of symptoms depending on which valve is affected. Conversely, an incompetent valve allows blood to flow in the wrong direction, minimizing the value of each stroke of the pump.
Cardiomyopathy: The heart muscle itself can become diseased, from coronary artery or valve disease, alcohol abuse, nutritional deficiencies, an infection, or certain chemical poisons. Although many patients have no symptoms, cardiomyopathy causes the heart to pump less efficiently and multiple symptoms may ensue including pain, fatigue, palpitations, passing out, and even sudden death.
Arrhythmias: In health, electrical impulses spread throughout the heart coordinating the systematic filling and emptying of the four cardiac chambers. If the conductor of this critical orchestra, the sino-atrial node (or pacemaker) or any of the wiring goes awry, heart rhythm may become irregular. This can present with an odd sensation in the chest, a sense of something being wrong, frank palpitations or fluttering in the chest, intermittent passing out, blindness, or strokes. Sometimes this can be provoked by too much caffeine but always merits being checked out.
Pericardial disease: The heart is surrounded by a sac or bag, the pericardium. This can become inflamed even impeding the heart from pumping properly. Inflammation of the sac, pericarditis, can be caused by a number of things. The pain mimics coronary artery disease but pericardial pain is often positional and the patient tends to sit leaning forwards taking shallow breaths. Sometimes fluid collects between the sac and the heart and this effusion can also impact the heart’s performance.
Heart failure: When the heart is not able to pump blood efficiently around the body, one or both sides can fail, allowing fluid to back up. If the right side fails, fluid collects in the lung impacting breathing; if the left side is impacted, fluid causes swelling throughout the body. The disease also causes weakness, but contrary to popular opinion heart failure does not mean the heart has stopped beating. This condition can be caused by a multitude of other diseases with coronary artery disease being the most common.
Obviously you cannot change what you were born with, but most heart disease is a reflection of lifestyle choices that you can impact. Firstly, ensure you are at your ideal weight, never smoke, eat a well-balanced diet, exercise judiciously, avoid stress, and have your blood pressure and fat profile checked by your doctor regularly. There are additional screening tests that may be germane to your particular circumstances—ask your doctor. If you detect any change in your exercise tolerance, shortness of breath, chest, neck or arm pain, or feeling your heart skip a beat (in the absence of the one you love), please see your doctor sooner rather than later. Because there may not be a later.
As always, if there are subjects you wish me to address, please do not hesitate to send me an email. And I mean that from the bottom of my heart.
July 14, 2011