Resources

Angina And Myocardial Infarction:

Meaning and difference: Angina typically means chest discomfort usually on exertion but can be noticed at rest. Myocardial infarction may present as angina but results in damage to heart muscle. Angina is usually felt as chest tightness in the middle/ retro-sternal but a typical symptoms can occur and radiation to arms, shoulders, fingers, jaws or back may be associated. It may be accompanied also with symptoms of shortness of breath, light headedness, nausea, vomiting or palpitations.

Cause: Narrowing of coronary arteries due to atherosclerosis (cholesterol, fibrous tissue, calcification, inflammation, spasm and clots) and there being a supply: demand mismatch. Essentially itis considered the heart’s cry for help.

Action needed: If in an emergency to call 000/ Ambulance. If otherwise, visit your GP to get access to your cardiologist.

Tests/ investigations: Functional tests like stress test/ stress echocardiogram may reveal abnormality suggesting coronary artery ischemia(reduced blood supply). Echocardiogram can demonstrate presence of heart muscle weakening, dilatation or valve leaks.Anatomic diagnosis to confirm the narrowing of coronary arteries involves a coronary angiogram but can also be noted on a CTCA/ CT coronary angiogram.For people who cannot physically walk on a treadmill, dobutamine stress echocardiogram or persantin nuclear imaging (M.I.B.I) is available.

Treatment: Medical treatment includes Aspirin (or other blood thinners/anti-platelets), nitrates, beta blockers, A.C.E. inhibitors/ A.R.B. Definitive treatment for severe coronary artery narrowing includes angioplasty and stents or in some cases coronary artery bypass surgery (C.A.B.G)

Congestive Heart Failure:

Meaning: CCF/ Congestive heart failure indicates inability of the heart muscle to function effectively as a pump to provide blood supply to the skeletal muscles and rest of the body organs.

Symptoms: Breathlessness initially on exertion that progresses to difficulty in breathing even at rest and on lying down. There may be times that sleep is interrupted due to waking up from gasping episodes.

Types: Different classifications but broadly divided into heart failure due to decreased contractility (HFREF) or increased stiffness (HFPEF). Also known as systolic dysfunction vs diastolic dysfunction although 1/3rdmay have a combination

Causes:

• Heart muscle injury from myocardial infarction (heart attack)
• Heart muscle weakness from cardiomyoliathy
• Valvular abnormalities like narrowing or leaks.
• Metabolic conditions like diabetes, anaemia, thyroid dysfunction, kidney failure, etc
• Genetic disorders.
• Congenital heart diseases
• Some drugs including alcohol abuse.
• Myocarditis (inflammation of heart muscle) or liregnancy related
• Stress related (Tako-Tsubo syndrome), etc

Action needed: If in an emergency to call 000/ Ambulance. If otherwise, visit your GP to get access to your cardiologist.

Tests/ investigations: Blood tests, ECG, Chest xray, Echocardiogram, coronary angiogram or M.I.B.I or cardiac MRI / CTCA as decided by the doctor in consultation with the patient.

Medications needed: May include diuretics(Fluid tablets), Angiotensin receptor and Neprilsyn inhibitors (ARNI), A.C.E.inhibitors or Angiotensin receptor blockers, beta blockers, statin, nitrates, digoxin.

Valvular Heart Disease:

Meaning and causes: Heart valves are naturally placed between the atria and ventricles (Mitral and tricuspid valves) and between the ventricles and the great arteries (Aortic and pulmonary valves) to allow unidirectional flow of blood. When due to various causes including ageing and calcification, rheumatic heart disease, connective tissue disorders, certain drugs, congenital heart disease, I.V drug abuse and heart attack, these valves may narrow (stenosis) or start leaking (regurgitation).

Symptoms: Breathlessness, chest pain, fatigue, palpitations, light headednessor fainting.

Action needed: If in an emergency to call 000/ Ambulance. If otherwise, visit your GP to get access to your cardiologist.

Tests needed: Echocardiogram, ECG, X ray chest and other tests depending on the causeor to rule out infection of valves.

Treatment: Medications to treat symptoms, surgical replacement, balloon dilation of valve (e.g mitral stenosis) or T.A.V.I (Trans catheter valve implantation through the arterial access)

Heart Blocks:

Meaning: Electrical conduction defects in the heart that leads to failure of proper sequential electrical stimulation of the heart chambers. The defect may be in at the atrial level (e.g sick sinus syndrome) or at the atrio-ventricular level ( A.V Blocks).

Symptoms: Lightheadedness, fainting (syncope), breathlessness or palpitations.

Causes: degenerative, valve disease like aortic stenosis, inherited disorders, infiltrative disorders, certain medications, etc.

Treatment: Pacemaker implantation is the usual definitive treatment particularly when symptomatic.

Atrial Fibrillation/ Flutter(AF):

Meaning: Chaotic rapid rhythm of the top chambers called atria that results in irregular heart beat, often fast. Due to loss of contraction and abnormal structure with increased tendency to form clots in this /these chambers, there is risk of developing stroke or peripheral arterial embolisation involving, kidneys, spleen or lower or upper extremities. This risk is higher in women, hypertensives, diabetics and people with previous vascular disease, coronary artery disease or stroke (CHA2DS2VASc score). AF affects approximately 400,000 Australians! AF costs the Australian economy over $1.25 billion/year.

Symptoms: May have no symptoms. Common symptoms are palpitations (racing heart sensation), breathlessness on exertion or at rest, chest pain, light headedness or even fainting (syncope). The first symptom may be of a stroke!

Causes/ risk factors: Age, genetic, male gender, hypertension, diabetes, kidney disease, pre-existing heart disease, valvular heart disease, obstructive sleep apnoea syndrome, kidney disease, post surgery, pulmonary embolism (lung clots), thyroid disorders, etc. No underlying cause may be sometimes identified (Lone AF).

Treatment: Rate and/or rhythm control, anti-coagulation (blood thinning). In some acute cases or select cases, cardioversion or electrical “shock” treatment may be necessary. Specific intervention for A.F. is called atrial fibrillation or flutter ablation using special catheters inserted through the groin into the heart.