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                                                                     Heart   Disease

                                                              Andrew Ying-Siu Lee, MD,PhD.

 

        Heart disease is comon disease, but high mortality.  Heart disease usually is sudden onset, intermittent, without

obvious precipitating factors or warning.  Most threatening of heart disease is sudden cardiac death.  Under ordinary

or resing situations, most heart diseases are asymptomatic.  During exertion or proper manipulation, symptoms of

heart disease occur.  Therefore ordinary physical examinations seldom detect heart disease, and we need cardiologists

to examine and treat heart disease.

 

                                                       Common symptoms of heart disease

1.  Chest pain:  Common heart disease symptom.  Heart disease causes include ischemic heart disease, pericarditis,

                         aortic dissection, pulmonary embolism etc.  Non heart disease causes include peptic disease,

                         pneumonia, trauma, skeletal muscular pain etc.

 

2.  Dyspnea:  Common heart disease symptom.  Dyspnea due to heart disease usually occurs during activity or

                      exertion.  Heart disease causes include heart failure, pulmonary heart disease etc.  Non heart disease

                      causes include pneumothorax, chronic pulmonary disease, pneumonia, pulmonary embolism,

                      anemia, anxiety etc.  Dyspnea due to heart failure includes orthopnea and paroxysmal nocturnal

                      dyspnea.

 

3.  Palpitation:  Common heart disease symptom.  Heart disease causes include cardiac arrhythmias,  mitral valve

                        prolapse, ischemic heart disease, valvular heart disease etc.  Non heart disease causes include over-

                        activity or emotional upset, thyroid disease, anemia, chronic pulmonary disease etc.

 

4.  Weakness:  Common heart disease symptom.  Causes include low heart output, heart failure etc.

 

5.  Pedal edema:  Common heart disease symptom.  Heart disease --> poor circulation --> decrease kidney

                            circulation --> decrease excretion of water and salt from kidney --> pedal edema.  Non heart

                            disease causes include kidney disease, hormonal imbalance etc.

 

6.  Dizziness/syncope:  Common heart disease symptom.  Heart disease causes include ischemic heart disease,

                            valvular heart disease, pulmonary heart disease or cardiac arrhythmias --> poor circulation -->

                            decrease brain circulation --> dizziness/syncope.  Non heart disease causes include hypoglycemia,

                            brain disease, anemia etc.

 

                                                                Types  of  heart  disease

1.  Hypertensive heart disease:

        Common heart disease.  Chronic hypertension may lead to ischemic heart disease, heart enlargement, heart

dysfunction, heart failure etc.  Hypertensive heart disease include primary hypertensive heart disease (causes unknown)

and secondary hypertensive heart disease (causes include renal artery stenosis, coarctation of aorta, hormonal disease etc).

 

        Majority patient of hypertensive heart disease are asymptomatic.  Sometimes, headache, dizziness, flushing of face,

cold sweating, chest discomfort, dyspnea etc may occur.

 

2.  Ischemic heart disease:

        Common heart disease.  Heart is mainly made up of heart muscle.  Left and right coronary arteries from aorta

supply blood (oxygen and nutrients) to heart. When heart vessels (=coronary arteries) undergo atherosclerosis,  stenoses

and occlusion, or because of hypertensive heart disease, valvular heart disease, heart enlargement, anemia,

over-activity or exertion, smoking etc, blood supply (oxygen and nutrients) to heart becomes insufficient leading to

"heart ischemia" or "myocardial ischemia". When heart ischemia becomes serious, it will lead to chest discomfort

(= angina pectoris),  decrease heart contractility (--> heart failure), damage heart conduction system

(--> cardiac arrhythmias), leading to "ischemic heart disease" or "coronary artery disease".

 

        Patients with ischemic heart disease have chest tightness or discomfort in lower jaw, left shoulder, left arm, upper

abdomen, especially during over-activity, emotional upset, seasonal changes, smoking etc.  The discomfort is

short (usually few minutes), and relieved upon rest or sublingual intake of nitroglycerin tablet.  This stage is  

"stable angina pectoris".  If chest pain becomes more serious and frequent, or occurs even at rest or minimal physical

activity, it becomes "unstable angina pectoris".  If the severe chest pain persists more than half an hour, associated

with dyspnea, cold sweating, nausea vomiting, dizziness/syncope, weakness, pale looking etc, it becomes

"myocardial infarction" (= total occlusion of heart vessels leading to myocardial necrosis).

 

        Patients with unstable angina or myocardial infarction need emergent consultation, otherwise heart disease

condition may worsen shortly leading to shock and death.

 

3.  Valvular heart disease:

        Common heart disease.  Owing to infections, rheumatic heart disease, congenital heart disease or acquired

heart disease like hypertensive heart disease, ischemic heart disease, pulmonary heart disease, the heart valves

become damaged (stenoses or regurgitations) leading to heart dysfunction and failure.

 

        Common symptoms of valvular heart disease include dyspnea, palpitation, dizziness/syncope, chest discomfort,

weakness, poor exercise tolerance, hemoptysis, hoarseness of voice, edema, heart failure etc.

 

4.  Heart failure:

        Common heart disease.  Owing to infections, rheumatic heart disease, congenital heart disease or acquired

heart disease like hypertensive heart disease, ischemic heart disease, pulmonary heart disease, the heart becomes

overload leading to poor heart contractility, heart enlargement, heart dysfunction and failure

(=terminal heart disease).  Non heart disease causes include pulmonary disease, thyroid disease, anemia,

alcoholism, toxins, drugs etc.

 

        Common symptoms of heart failure include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, chest discomfort,

palpitation, edema, weakness etc.

 

5.  Cardiac arrhythmias:

        Common heart disease.  When the formation or conduction of heart impulses become abnormal, or

there is blockade of heart conduction system, cardiac arrhythmias occur leading to irregular heart beats.

 

        There are many causes and types of cardiac arrhythmias.  Heart disease causes include ischemic heart disease,

hypertensive heart disease, valvular heart disease, rheumatic heart disease, cardiomyopathies etc.  Non heart disease

causes include thyroid disease, metabolic disease, drugs, toxins, electrolyte imbalance, infections, pulmonary disease etc.

Symptoms of cardiac arrhythmias range from mild palpitation, dizziness, chest discomfort, dyspnea, weakness, to fatal

complications like heart failure, shock, stroke, coma and sudden death.

 

6.  Pulmonary heart disease:

        Common heart disease.  Owing to chronic pulmonary disease or pulmonary artery disease,  there are pulmonary

hypertension, right heart enlargement and failure.  Symptoms of pulmonary heart disease include dizziness, dyspnea,

weakness, edema, abdominal pain, chest pain, heart failure, cyanosis etc.

 

7.  Cardiomyopathies:

        Common heart disease.  Owing to toxic, metabolic, immunological, genetic, infectious factors,  heart muscle

become damaged and dysfunctioned.  Cardiomyopathies include dilated, restrictive and hypertrophic

cardiomyopathies.  Symptoms include dyspnea, chest discomfort, dizziness, palpitation, weakness, edema, heart failure.

 

8.  Heart inflammation:

        Common heart disease.  Infections lead to pericarditis, myocarditis, endocarditis or valvulitis or valvular pathology.

Drugs, chemicals, radiations, immunological reactions may also cause heart inflammation.  Symptoms include

chest pain, muscle pain, joint pain, abdominal pain, fever, chill, weakness, palpitation, dizziness, heart failure,

sudden death etc.

 

9.  Rheumatic heart disease:

        Common heart disease.  Rheumatic heart disease is secondary to acute rheumatic fever which damages the heart.

Acute rheumatic fever is secondary to the immunologic reactions due to B-streptococcal infection of upper respiratory

tract, damaging the heart, joints, skin and brain.

 

        Rheumatic heart disease frequently leads to heart inflammation (pericarditis, myocarditis, endocarditis) and

valvular pathology like mitral and aortic valvular stenoses or regurgitations.

 

10.  Congenital heart disease:

        Common heart disease.  Congenital heart disease is abnomaly of heart due to inhibition of heart formation and

development, usually occurring during 4-8 weeks pregnancy.  Causes of congenital heart disease include genetic

factors, infection of uterus, radiation, drugs etc.

 

        Most common symptoms of congenital heart disese is heart murmur.  Other symptoms include dyspnea, growth

retardation, edema, cyanosis, palpitation, heart failure etc.

 

        Congenital heart disese is divided into cyanotic congenitial heart disease and acyanotic congenital heart disease.

Please refer to the respective slide presentations in [Heart disease and Health Slide Presentation].

 

        Congenital heart disease is treatble and needs early diagnosis and treatment.

 

                                                   Risk  factors  of  heart  disease

1.  hypertension may lead to heart disease/worsen heart disease

2. diabetes may lead to heart disease/worsen heart disease

3. smoking may lead to heart disease/worsen heart disease

4. obesity may lead to heart disease/worsen heart disease

5.  hyperlipidemia may lead to heart disease/worsen heart disease

6.  heredity, family history may lead to heart disease/worsen heart disease

7.  alcoholism may lead to heart disease/worsen heart disease

8.  heart disease occur more frequently in old age

9.  heart disease occur more frequently in male gender

10.  heart disease occur more frequently after menopause

11.  stressful life, emotional upsets, lack of leisure may lead to heart disease/worsen heart disease

12.  overworking, lack of rest and sleep may lead to heart disease/worsen heart disease

13.  diet (too salty, high calorie, high lipid food) may lead to heart disease/worsen heart disease

14.  infections may lead to heart disease/worsen heart disease

15.  other systemic disease may lead to heart disease/worsen heart disease

16.  environmental toxins like lead, radiation, microwave may lead to heart disease/worsen heart disease

17.  use of contraceptives, hormones may lead to heart disease/worsen heart disease

18.  drug abuse may lead to heart disease/worsen heart disease

 

                                            Preventive  measures  of heart  disease

1.  first, avoid risk factors of heart disease

2.  low salt diet may ameliorate heart disease/prevent heart disease

3.  low calorie diet may ameliorate heart disease/prevent heart disease

4.  low fat diet may ameliorate heart disease/prevent heart disease

5.  fruits and vegetables may ameliorate heart disease/prevent heart disease

6.  fluid restriction may ameliorate heart disease/prevent heart disease

7.  regular exercise may ameliorate heart disease/prevent heart disease

8.  cardiac rehabilitation program may ameliorate heart disease/prevent heart disease

9.  weight control may ameliorate heart disease/prevent heart disease

10.  balanced diet may ameliorate heart disease/prevent heart disease

11.  healthy life style may ameliorate heart disease/prevent heart disease

12.  ample sleep may ameliorate heart disease/prevent heart disease

13.  avoid night life, early wake-up and bed time may ameliorate heart disease/prevent heart disease

14.  regular physical examination may ameliorate heart disease/prevent heart disease

15.  regular medication and follow-up, compliance to doctors  may ameliorate heart disease/prevent heart disease

16.  no smoking may ameliorate heart disease/prevent heart disease

17.  no alcohol abuse may ameliorate heart disease/prevent heart disease

18.  control hypertension may ameliorate heart disease/prevent heart disease

19.  control diabetes may ameliorate heart disease/prevent heart disease

20.  control infection may ameliorate heart disease/prevent heart disease

21.  control other systemic disease may ameliorate heart disease/prevent heart disease

22.  avoid too much coffee, strong tea etc may ameliorate heart disease/prevent heart disease

23.  avoid overworking, ample leisure may ameliorate heart disease/prevent heart disease

24.  regular defecation, do not abstain from voiding may ameliorate heart disease/prevent heart disease

25.  nonstressful environment may ameliorate heart disease/prevent heart disease

26.  keep body temperature stable in different seasons may ameliorate heart disease/prevent heart disease

27.  maintain joyful  social activity, emotional stability may ameliorate heart disease/prevent heart disease

28.  good natural environment  may ameliorate heart disease/prevent heart disease

29.  good hygiene may ameliorate heart disease/prevent heart disease

30.  good social environment may ameliorate heart disease/prevent heart disease