Heart Conditions

Learning that you have a heart condition is a major event in your life. It can have a significant effect on you socially, physically and emotionally.

Understanding the impact, and learning about your condition and its treatment, are important steps in managing the impact – on you, and on your family and friends.

Feelings and Reactions

Like many people, you may have experienced shock, anxiety, grief and other emotions. Your reactions may have taken you by surprise, but rest assured, these feelings are normal. Understanding them will help you and those close to you.

Common feelings include:

anxiety and stress about the future
confusion over changing roles in the family
sense of losing control of your life
fear of changes in your lifestyle
fear of resuming physical and sexual activity
anxiety about work commitments
fear of a slow recovery.

You can end up feeling stressed, helpless and depressed. These are normal reactions to a crisis, and the health professionals you deal with understand that you and your family need support and respect.

Heart Conditions

Arrhythmia
Atherosclerosis
Angina
Atrial Fibrillation
Cardiac Arrest
Cardiomyopathy
Congenital Heart Disease
Coronary Heart Disease
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Familial Hypocholesterolaemia
Heart Attack
Heart Failure
Heart Valve Disease
Inherited Heart Conditions

Heart Conditions

Arrhythmia

Arrhythmias occur when the heart stops beating in a regular rhythm or beats too fast or too slow. This happens when there is a malfunction in some part of the heart’s electrical system. This system transfers electrical impulses around the heart causing the heart muscle to contract (i.e. heartbeat). Arrhythmias can be felt in different ways. Some of the feelings associated with arrhythmias include:

Skipping a heartbeat
Occasional extra heartbeats and
Rapid heartbeat or pounding in the chest

Some arrhythmias are not serious and may occur in healthy hearts. Other arrhythmias may need medical treatment.

A normal heart rate is around 60 – 1oo beats per minute. When the heart rate beats too fast or slow, this will be referred to as an arrhythmia. Common terms associated with arrhythmia are:

Tachycardia is when your heart beats too quickly, usually more than 100 beats per minute.
Bradycardia is when the heart beats too slowly, usually less than 50 beats per minute.
Atrial Fibrillation is a type of abnormal heart rhythm. It causes the upper chambers of the heart to beat rapidly and out of rhythm with the lower chambers of the heart. This causes the irregular heart rhythm and can reduce the ability of the heart to pump blood efficiently through the body.
Supraventricular tachycardia (SVT) is as an abnormally fast or erratic heartbeat that affects the heart’s upper chambers. During an episode of SVT, your heart can beat about 150 to 220 times per minute, but it can occasionally beat faster or slower. Most people with supraventricular tachycardia are able to live healthy lives without any form of restrictions or treatment. For others, they may require some lifestyle changes, medication and/or heart procedures to control or eliminate the rapid heartbeats and related symptoms

Knowing your pulse can help you determine if you have an arrhythmia. Taking your pulse for just 30 seconds at several different times of the day, including before and after various activities, can give you an understanding of your regular rhythm and help you understand if anything changes. It is normal for your pulse to vary over the day and around activities such as exercise. Taking your pulse when you first wake in the morning and at night before bed can help you determine your baseline rhythm.

On taking your pulse, count for 30 seconds then multiply by 2 to get your heart rate in beats per minute. If you notice your rhythm is irregular count for the full 60 seconds instead of multiplying.

If you have a persistent heart rate above 120 bpm or below 40 bpm and/or if the rhythm is irregular, too fast, too slow you should see your Doctor.

If you your doctor diagnoses an arrhythmia, they will explain your particular arrhythmia to you in more detail including its cause and treatment and answer any questions you may have.

Atherosclerosis

Atherosclerosis is a process in which blood, fats such as cholesterol, and other substances build up on your artery walls. Eventually, deposits called plaques may form. The deposits may narrow or block your arteries. These plaques can also rupture, causing a blood clot.

It’s the condition that causes most heart attacks and strokes.

Over time, atherosclerosis can lead to:

Angina – usually a pain or discomfort in your chest. This happens when your heart muscle isn’t getting enough blood.
Heart attack – if the fatty material breaks down and a blood clot forms, it can completely block your artery and cut off the supply of blood to your heart. This is a heart attack.
Stroke – when enough blood can’t get to your brain. If the blood supply is limited for a short time this can cause a mini-stroke (called a TIA). If the fatty material breaks down and a blood clot forms, it can completely block the artery.
Peripheral arterial disease (or PAD) – when enough blood can’t get to your leg muscles. This can cause pain in your calves, hips, buttocks and thighs – usually when you’re walking or exercising

Symptoms
There are no visible symptoms of atherosclerosis until you suffer from angina or have a heart attack.
Regular health checks, especially if you are over 40, will check your risk of having a heart attack, and based on your results, your GP can tell you how to keep your heart healthy.

Angina

Angina is a feeling of chest pain or discomfort, typically during activity such as walking, or when you have strong emotions.

You may experience this if your heart is not getting enough blood and oxygen. This may be caused by a narrowing of the coronary arteries.

Each person may experience different sensations, so it is important that you know and recognise your symptoms:

Dull pain, tightness or heaviness in the centre of your chest
A squeezing or choking sensation
Shortness of breath
Pain in the shoulders and/or arms
Sometimes discomfort in the neck or jaw

Less common symptoms

Sweating
Pain through from the chest to the back
Fainting
Sensations similar to heartburn

When to get help
If you experience angina during physical activity, slow down, stop and use your angina medications. Contact your doctor for a review.

If symptoms do not stop after 15 minutes, treat it as a heart attack and ring for an ambulance (000 in Australia). They will decide whether you should go to hospital.

Atrial Fibrillation

Atrial fibrillation is a very common condition that makes the heart beat irregularly unlike the normal heartbeat that is regular.

The heart normally beats at a regular rate of between 60 and 80 beats per minute.

In atrial fibrillation (also known as AF and A Fib), instead of firing from the sino-atrial node, a number of impulses fire in different areas of upper chambers (atria). This causes individual muscle fibres to contract or fibrillate.

The upper chambers (atria) contract so rapidly that the lower chambers (ventricles) only respond to those impulses that are transmitted to the intermediate node (the atria-ventricular node, between the upper and lower chambers).

Fibrillation of the atria also decreases the amount of time the ventricles have to fill with blood. So the heart does not pump with the same efficiency. This reduces its output (the volume of blood pumped out of the heart to provide oxygen to the body).

Signs and symptoms:

Irregular heart rate (pulse)
Dizziness
Shortness of breath
Occasionally chest pain

Most people with atrial fibrillation have an underlying heart condition, such as coronary heart disease, heart attack (myocardial infarction), rheumatic heart disease, hypertension (high blood pressure), heart failure, cardiomyopathy, valve disease. It can also be caused by heart surgery.

Cardiac Arrest

Cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease.

The term “heart attack” is often mistakenly used to describe cardiac arrest. While a heart attack may cause cardiac arrest and sudden death, the terms don’t mean the same thing.

Heart attacks are caused by a blockage that stops blood flow to the heart.

Cardiac arrest is caused when the heart’s electrical system malfunctions. In cardiac arrest, death results when the heart suddenly stops working properly. This may be caused by abnormal, or irregular, heart rhythms (called arrhythmias).

A cardiac arrest is an emergency. If you witness a cardiac arrest, you can increase the person’s chances of survival by following CALL, PUSH, SHOCK. Call 000 immediately and give CPR. Ask someone to find the nearest defibrillator to use.

CPR means:

chest compression (pumping the heart by external cardiac massage), to keep the circulation going until the ambulance arrives and
rescue breathing (inflating the lungs by using mouth-to-mouth resuscitation)

Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle. In most cases, it causes the heart muscle to become weak and ineffective. When the heart can no longer pump enough blood to meet the needs of the body, it is called heart failure.

There are three major types of cardiomyopathy.

Dilated cardiomyopathy (often called congestive heart failure or CHF) is the most common. The heart muscle becomes damaged and enlarged, therefore less effective. This can in turn lead to heart failure. Fluid builds up in the lungs and often in the abdomen and ankles, leading to swelling in these areas.

Hypertrophic cardiomyopathy is a genetic disorder that causes muscle cells to grow within the ventricles – the lower parts of the heart. The thickened heart muscle can lead to problems pumping enough blood through the body, and it places greater strain on the heart.

Restrictive cardiomyopathy is a rare condition where abnormal cells, protein, or scar tissue develop inside the heart, often after a heart transplant. This leads to stiffening of the heart tissue, and the heart cannot fill as much as it should. Blood is backed up in the lungs and swelling occurs, making it harder to breathe.

Treatment
Cardiomyopathy cannot usually be completely cured. However, it can be controlled or managed by treatments including medication, pacemakers and implantable defibrillators.

Congenital Heart Disease

Congenital heart disease is the most common congenital disorder in newborns and is the leading cause of death of Australian babies. Congenital defects are often diagnosed in infancy, or even before birth. Some defects are harder to detect than others and may not be diagnosed until much later in childhood or even adulthood and defects depend on how the heart has developed.

Congenital heart disease is an umbrella term for a group of abnormalities of the heart and can describe any type of malformation of the heart, heart valves or major blood vessels which are present at birth.

For many babies diagnosed with congenital heart disease, their condition is a minor problem which either doesn’t need any treatment or can be successfully corrected with surgery. There is no known cure for congenital heart disease but survival rates have improved following medical interventions thanks to research and improved medical care and technology.

The majority of cases (approx. 8 out of 10) of congenital heart disease have no known cause. Things that may cause congenital heart disease include:

Problems with genes or chromosomes in the child, such as Down Syndrome
Taking certain medications, large amounts of alcohol or drug abuse during pregnancy
A viral infection, such as rubella (German measles) in the mother during the first trimester of pregnancy.

Coronary Heart Disease

Coronary Heart Disease (also known as Coronary Artery Disease) is the narrowing of the blood vessels that supply oxygen and other nutrients to the heart muscle.

Coronary heart disease is caused by a process known as atherosclerosis: the gradual build-up of substances such as cholesterol in the arteries of the heart. Often called plaque, or atheroma, this substance makes the arteries narrower, so the heart has to work harder to pump blood through them.

Atherosclerosis underpins most cardiovascular diseases. It usually begins in early adulthood, or long before any symptoms develop. Often people live for many years with this build-up increasing, and have no symptoms. But it can lead to serious complications, such as:

Coronary thrombosis. Sometimes a blood clot forms at a narrowed point in the artery, blocking the flow of blood altogether. This is called coronary thrombosis or coronary occlusion
Angina, chest pain or discomfort
Heart attack

Treatment
Coronary artery disease doesn’t go away, so it is treated according to how bad the symptoms are, and where and how serious the blockages are. Treatments include medication, stents and coronary artery bypass.

Catecholaminergic Polymorphic Ventricular Tachycardia CPVT

CPVT is a rare inherited heart rhythm disturbance found in young people and children.

Within your heart cells, proteins regulate the release of calcium ions. If these proteins function abnormally, it can lead to a rise in the level of calcium inside your cells. This rise in calcium can cause abnormal heart rhythm.

Symptoms
The most common symptoms of CPVT are blackouts, palpitations and dizziness. These can be brought on by strenuous physical activity and heightened emotions, which can cause an increase in the amount of adrenaline running through your blood.

If you experience symptoms, your doctor will refer you to a specialist who will do an exercise test. This is an ECG that records your heart’s electrical rhythm whilst you are exercising. Any abnormal rhythms will show up on the ECG.

Genetic testing can also be done if someone in your family has already been diagnosed with CPVT even if you don’t have symptoms of the condition.

Treatment
Your doctor may prescribe a beta-blocker (a type of medicine) to help slow down your heart rate and help to prevent life-threatening arrhythmias, and restrict the amount of physical activity you do. Roughly 1 in 3 people also need to be fitted with an Implantable Cardioverter Defibrillator (ICD).

Familial Hypercholesterolaemia

Familial hypercholesterolaemia (FH), is a genetic condition that results in exceptionally high levels of cholesterol in your blood.

If you have Familial Hypercholesterolaemia (FH), your liver can’t remove enough of the bad type of cholesterol (LDL cholesterol) from your blood. This means that the bad type of cholesterol in your blood remains high which can cause a fatty material build up in your arteries which could cause a heart attack.

Treatment
There isn’t a cure for FH, but it can be treated successfully. Many people with FH take a medicine called a statins, which helps lower your cholesterol levels. You should also make sure that you have a healthy diet, maintain a healthy weight, and take plenty of exercise.

Heart Attack

Each year, around 54,000 Australians suffer a heart attack. Every 9 minutes someone in Australia has a heart attack.

A heart attack occurs when the narrowing of the artery becomes completely blocked, causing the heart muscle beyond the blockage to become oxygen starved.

Heart Research Australia, in association with Royal North Shore Hospital and North Shore Private Hospital, has created the video below to provide information about heart attack, the warning signs and how it is treated.

Click the arrow below to view the video.

Symptoms

The symptoms of a heart attack can be similar to those for angina, with the addition of any or all of the following:

Dull pain, chest tightness or discomfort that becomes more severe and does not go away
Jaw and neck pain
Severe pain that is often described as ‘crushing’
A squeezing or choking sensation
Nausea / feeling sick in the stomach
Fainting
Sweating
Pain the shoulder and/or arms
Pain from the chest to the back
Similar sensations to heart burn
Sudden difficulty breathing
Sudden overwhelming fatigue or weakness
Flu-like symptoms

If you or someone else experience any combination of these symptoms for more than a few minutes, immediately call 000 for an ambulance.

Heart Attack Action Plan
If you think someone may be having a heart attack, regard this as an emergency. Do not waste vital moments. Rather than going to a doctor’s clinic, take these steps:

Dial triple zero (000) in Australia.
Ask for ambulance service.
Report a possible heart attack.
Give the person an aspirin if you have any, unless they have been advised not to take this particular medication.
Make sure they rest quietly while you wait for transport or an ambulance.
If an ambulance is not readily available (for example, in some rural areas), quickly notify the nearest hospital, health clinic or the person’s usual doctor for advice.

Heart Failure

Heart failure occurs when the heart cannot pump enough blood through the body.

Common causes of heart failure are heart attack and high blood pressure, but there are many other causes.

If your heart muscle is not pumping as efficiently as normal, you may experience:

Shortness of breath
Swelling of the ankles
Weakness
Fatigue

See your doctor if you have some or all of these symptoms.

Heart Valve Disease

Heart valve disease can affect any of the valves in your heart. Your heart valves have flaps that open and close with each heartbeat, allowing blood to flow through the heart’s upper and lower chambers and to the rest of your body. The upper chambers of the heart are the atria, and the lower chambers of the heart are the ventricles.

The heart valves work by ensuring that blood flows in a forward direction and doesn’t back up or cause leakage. If you have a heart valve disorder, the valve isn’t able to do this job properly.

This can be caused by a leakage of blood, which is called regurgitation, a narrowing of the valve opening, which is called stenosis, or a combination of regurgitation and stenosis.

Symptoms
Some people with a heart valve disorder may not have any symptoms, while others may experience conditions like strokes, heart attacks, and blood clots if the heart valve disorder goes untreated.

Many of the symptoms are similar to those associated with congestive heart failure, such as shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles, hands or abdomen (edema). Other symptoms include:

Palpitations, chest pain (may be mild)
Fatigue
Dizziness or fainting (with aortic stenosis)
Fever (with bacterial endocarditis)
Rapid weight gain

Treatment
You may not need any treatment at all but your doctor may ask you to come back in a year’s time for review, or if your symptoms get worse.
Most valve problems can be treated using medicines or by valve heart surgery. Your treatment will depend on the cause of your problem and the effect that it is having on your heart.

Inherited Heart Conditions

Many cardiac disorders can be inherited, including arrhythmias, congenital heart disease, cardiomyopathy, and high blood cholesterol. Coronary artery disease leading to heart attack, stroke, and heart failure can run in families, indicating inherited genetic risk factors.

Genetics can influence the risk for heart disease in many ways. Genes control every aspect of the cardiovascular system, from the strength of the blood vessels to the way cells in the heart communicate. A genetic variation (mutation) in a single gene can affect the likelihood of developing heart disease.

When a family member is diagnosed with heart disease or a heart disorder, other family members are encouraged to undergo screening for risk factors and early stage disease that may not yet produce symptoms.

Share your family history with your healthcare provider to understand your risks.