Dr Dulcy on heart health

SOBERING FACT: MOST HOSPITAL PATIENTS ARE THERE BECAUSE OF A DODGY TICKER

Cardiac disease claims worrying 210 lives every day.

Heart failure and stroke are leading causes of death in adult South Africans; more than four times the number of people who are murdered. It is the leading cause of hospitalisation in people older than age 65.

Heart disease is one of the most serious threats to the health of our nation and it’s mainly due to our lazy, Western lifestyle. It’s interesting to note that although 49 people are murdered in SA every day, a whopping 210 die of heart disease every day.

Heart failure does not mean the heart has stopped working. Rather, it means the heart’s pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate and pressure in the heart increases.

As a result, the heart cannot pump enough oxygen and nutrients. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently.

As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

DIAGNOSIS

The diagnosis is mainly made by history and examination. The doctor will ask you about any conditions you have that may cause heart failure (such as coronary artery disease, angina, diabetes, heart valve disease, and high blood pressure). You will be asked if you smoke, take drugs, drink alcohol (and how much you drink), and about what drugs you take. Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:

Blood tests Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anaemia.

B-type natriuretic peptide (BNP) blood test BNP is a substance secreted from the heart in response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable.

Chest X-ray A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.

Echocardiogram This test is an ultrasound which shows the heart’s movement, structure, and function.

The ejection fraction It is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present.

Electrocardiogram An ECG records the electrical impulses traveling through the heart.

Cardiac catheterisation This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.

Stress test Noninvasive stress tests provide information about the likelihood of coronary artery disease.

CAUSES

Heart failure is caused by many conditions that damage the heart muscle, including:

Coronary artery disease Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.

Heart attack A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.

Cardiomyopathy Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.

Conditions that overwork the heart Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.

SIGNS AND SYMPTOMS

If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.

The symptoms can include:

Congested lungs Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung

congestion can also cause a dry, hacking cough or wheezing.

Fluid and water retention Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called oedema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.

Dizziness, fatigue, and weakness Less blood to your major organs

and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.

Rapid or irregular heartbeats

The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.