HEART DISEASE

Symptoms of Coronary Artery Disease

The most common symptom of coronary artery disease is angina, or chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your chest that may also be felt in the shoulders, arms, neck, throat, jaw, or back.

Other symptoms of coronary artery disease include:

• Shortness of breath
• Palpitations (irregular heart beats, or a “flip-flop” feeling in your chest)
• A faster heartbeat
• Weakness or dizziness
• Nausea
• Sweating

Symptoms of a Heart Attack

• Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
• Discomfort radiating to the back, jaw, throat, or arm
• Fullness, indigestion, or choking feeling (may feel like heartburn)
• Sweating, nausea, vomiting, or dizziness
• Extreme weakness, anxiety, or shortness of breath
• Rapid or irregular heartbeats

Heart attack symptoms may last 30 minutes or longer and are not relieved by rest or oral medications. Initial symptoms may progress from mild discomfort to significant pain.

Some people have a heart attack without having any symptoms, “silent” myocardial infarction (MI), which occurs more often in people with diabetes.

Symptoms of Arrhythmias

• Palpitations (a feeling of skipped heart beats, fluttering or “flip-flops” in your chest)
• Pounding in your chest
• Dizziness or feeling light-headed
• Fainting
• Shortness of breath
• Chest discomfort
• Weakness or fatigue (feeling very tired)

Symptoms of Atrial Fibrillation

Atrial fibrillation (AF) is a type of arrhythmia. Most people with AF experience one or more of the following symptoms:

• Heart palpitations (a sudden pounding, fluttering, or racing feeling in the heart)
• Lack of energy
• Dizziness (feeling faint or light-headed)
• Chest discomfort (pain, pressure, or discomfort in the chest)
• Shortness of breath (difficulty breathing during normal activities)

Episodes may be brief.

Symptoms of Heart Valve Disease

• Shortness of breath and/or difficulty catching your breath; you may notice this most when you are doing your normal daily activities or when you lie down flat in bed.
• Weakness or dizziness
• Discomfort in your chest; you may feel a pressure or weight in your chest with activity or when going out in cold air.
• Palpitations (this may feel like a rapid heart rhythm, irregular heartbeat, skipped beats, or a flip-flop feeling in your chest.)

If valve disease causes heart failure, symptoms may include:

• Swelling of your ankles or feet; swelling may also occur in your abdomen, which may cause you to feel bloated.
• Quick weight gain (a weight gain of two or three pounds in one day is possible.)

You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show minor valve disease.

Symptoms of Heart Failure

Symptoms of heart failure can include:

• Shortness of breath noted during activity (most commonly) or at rest, especially when you lie down flat in bed
• Cough that produces white sputum.
• Rapid weight gain (a weight gain of two or three pounds in one day is possible.)
• Swelling in ankles, legs, and abdomen
• Dizziness
• Fatigue and weakness
• Rapid or irregular heartbeats
• Other symptoms include nausea, palpitations, and chest pain.

You may have many symptoms, but your heart function may be only mildly weakened. Or you may have a severely damaged heart, with few or no symptoms.

Symptoms of Congenital Heart Defects

This is mostly seen at birth or in infants and children. It is possible to have a defect and no symptoms at all. In adults, if symptoms of congenital heart disease are present, they may include:

• Shortness of breath
• Limited ability to exercise
• Symptoms of heart failure (see above) or valve disease (see above)

Congenital Heart Defects in Infants and Children

• Cyanosis (a bluish tint to the skin, fingernails, and lips)
• Fast breathing and poor feeding
• Poor weight gain
• Recurrent lung infections
• Inability to exercise

Symptoms of Heart Muscle Disease

Many people with heart muscle disease, or cardiomyopathy, have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as heart function worsens.

Symptoms of cardiomyopathy may occur at any age and may include:

• Chest pain or pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals)
• Heart failure symptoms (see above)
• Swelling of the lower extremities
• Fatigue
• Fainting
• Palpitations (fluttering in the chest due to abnormal heart rhythms)

Some people also have arrhythmias. These can lead to sudden death in a small number of people with cardiomyopathy.

Symptoms of Pericarditis

• Chest pain which is different from angina (chest pain caused by coronary artery disease); it may be sharp and located in the center of the chest. The pain may radiate to the neck and occasionally, the arms and back. It is made worse when lying down, taking a deep breath in, coughing, or swallowing and relieved by sitting forward.
• Low-grade fever
• Increased heart rate

DIAGNOSIS

Diagnosis can be made through physical examination and certain laboratory tests. Here are some examinations on your heart that your doctor may do.

Checking Your Heart Rate

Your doctor feels your pulse in order to check your heart’s rate and rhythm. Each pulse matches up with a heartbeat that pumps blood into the arteries, thus evaluating the amount (strength) of blood flow to different areas of your body.

Your heart rate is the amount of times your heart beats in one minute. You can get your heart rate by counting your pulse within 60 seconds.

Checking Your Heartbeat

The doctor can evaluate your heart and valve function and hear your heart’s rate and rhythm by listening to your heart sounds through the use of a stethoscope.

Checking Your Blood Pressure

Blood pressure is the force or pressure exerted in the arteries by the blood as it is pumped around the body by the heart. It is recorded as two measurements:

• Systolic blood pressure. Pressure in the arteries during the period of the heart’s contraction (the higher number)
• Diastolic blood pressure. Pressure in the arteries when the heart is relaxed, between heartbeats (the lower number)

Blood pressure is measured in millimeters of mercury (mm Hg).

Normal blood pressure for an adult, relaxed at rest, is less than or equal to 140 over 90. The 140 is the systolic pressure; the diastolic pressure is 90. Blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take.

Checking Your Heart by a Physical Exam

Your doctor can also tell about your heart’s function by examining other parts of your body, such as your eyes, arms, legs, and skin.

Checking Your Heart Through Blood Tests

Your doctor may recommend a blood test to check your cholesterol and other markers that may indicate heart disease.

RECOMMENDED MEDICATIONS

Treatment for Coronary Artery Disease

• Aspirin
• ACE inhibitors
• Beta-blockers
• Drugs for high blood pressure and high cholesterol
• Surgical treatments such as balloon angioplasty (usually using a metal stent to prop open the vessels) or open heart surgery to bypass blocked heart arteries

Treatment for Heart Failure

Treatment usually depends on the cause of heart failure.

• Diuretics or water pills
• Beta-blockers
• ACE inhibitors
• Pacemakers
• Defibrillators heart transplantation in very advanced cases

Treatment for Heart Arrhythmias

Treatment depends on the type of arrhythmia you have.

• Beta-blockers
• Drugs to help convert your rhythm to normal
• Drugs to prevent blood clots (such as warfarin and dabigatran)
• Cardioversion

Treatment for Heart Valve Disease

In severe cases, patients may require medications to deal with heart failure, or surgery to repair or replace the abnormal valve.

Treatment for Pericardial Disease

Pericarditis often subsides on its own, but it also can be treated with aspirin or, in severe cases, corticosteroid hormones. In the rare circumstance that pericarditis becomes a chronic condition, surgery may be needed to either create a pathway for the extra fluid to drain internally or remove the pericardial sac altogether.

Treatment for Cardiomyopathy (Heart Muscle Disease)

Treatment and outcome for cardiomyopathy will depend upon the underlying cause. The treatment often includes the same measures used for patients with heart failure. In selected cases, heart transplant surgery may be recommended.

Treatment for Congenital Heart Disease

Some minor conditions can actually clear up on their own, or can be treated easily with medications. Those that are more complex can often be treated surgically, if necessary. Very rarely, the heart problem is so severe that it cannot be corrected.