Heart disease, or coronary heart disease (CHD) to call it by its medical name, happens when your arteries become
narrowed through a process called Atherosclerosis. When this happens the blood and oxygen supply to the heart muscle is restricted,
particularly when you exert yourself and the demands of the heart muscle increase. The
main symptom of coronary heart disease is angina, caused by insufficient oxygen reaching your heart muscle because of the
lessened blood flow. Angina is a feeling of heaviness, tightness or pain in the middle of your chest that may extend to, or
just affect, your arms, neck, jaw, face, back or abdomen.
It is most often experienced during exertion - for example
if you run for a bus, play a game such a tennis or football, climb stairs or walk uphill. It may come on in cold weather,
after a heavy meal or when you are feeling stressed. It can subside once you stop what you are doing or take medication.
Unfortunately, for many people the first indication that something is wrong is a heart attack, or myocardial infarction.
This happens when the blood supply to a part of the heart muscle is interrupted or stops, usually because of a blood clot
in the coronary artery. The pain of a heart attack maybe severe or maybe mistaken for indigestion but unlike angina it doesn't
go away. Other symptoms include sweating, light-headedness, nausea or breathlessness which unlike angina are not alleviated
by rest. The following symptoms are by no means always due to coronary heart disease and could be harmless
or due to other medical conditions. However if you experience any of them it is a good idea to make an appointment to see
your doctor:.
- Unusual breathlessness when doing light activity
or at rest, or breathlessness that comes on suddenly.
- Angina - chest pain,
heaviness or tightness in the chest that comes on during exertion, emotional stress and may spread to arms, neck, jaw, face,
back or stomach.
- Palpitations - awareness of your heart beat or a feeling
of having a rapid and unusually forceful heart beat, especially if they last for several hours or recur over several days
and/or cause chest pain, breathlessness or dizziness.
- Fainting - although
not always a serious symptom, fainting is due to insufficient oxygen reaching the brain which may be due to many reasons,
so you should report it to your doctor.
- Fluid retention or puffiness - (oedema
to use the medical term) is abnormal accumulation of fluid in tissues such as ankles, legs, lungs and abdomen. Although usually
perfectly normal e.g. on a hot day, it can be a sign that the heart is not pumping as well as it should (heart failure).
- Bluish tinged fingernails or around lips - known medically as cyanosis - it
can be a result of too little-oxygen in the blood.
- Fatigue - fatigue is
a very common symptom with numerous causes including depression. It is always worth seeing the doctor if you feel unusually
tired, especially if it is combined with symptoms that can not be explained.
- Severe
crushing chest pain that may come on at rest and is accompanied by sweating, light-headedness, nausea or shortness
of breath and lasts more than 15 minutes may be a heart attack. Seek medical help immediately by phoning 999 and asking for
an ambulance. This will ensure prompt treatment and less damage to heart muscle may occur.
The overwhelming cause of coronary heart disease is atherosclerosis. This is a build up of fatty materials within
the walls of the arteries.
This occurs when the inner lining of your artery walls becomes furred with a thick,
porridge-like sludge (atheroma) made up of fatty deposits of cholesterol, cell waste and other substances. These form raised
patches on the artery wall known as 'plaques' which narrow the arteries reducing the space through which blood can
flow. At the same time the blood becomes more prone to clotting.
The growing plaques may block the delivery of
nutrients to the artery walls, causing them to lose their elasticity. This in turn may lead to high blood pressure, which
also increases the risk of coronary heart disease. Scientists have still to unravel
all the causes of heart disease. However, certain factors can increase your likelihood of developing it. These are known as
risk factors.
Some risk factors you cannot do very much about - such as your age, your gender or your ethnic group.
Risk factors you do have some control over are what you eat, whether you smoke and the amount of exercise you take. Key risk
factors include:
• Your age
It has been recognised that the risk of developing
coronary heart disease increases with age. Atherosclerosis takes a long time to develop and the arteries naturally become
less elastic as we age, often leading to a greater risk of high blood pressure.
• Your gender
Many people think of coronary heart disease as being a male problem. However this is far from being the case. In fact
coronary heart disease accounts for more deaths of women than any other disease.
The female sex hormone, oestrogen, protects
against coronary heart disease during the reproductive years by creating a more favourable balance of blood fats and by contributing
to the elasticity and health of the arteries. However, after the menopause - or following a total hysterectomy in which the
ovaries were also removed as well as the uterus thus depriving the body of oestrogen - this natural protection can disappear.
• Your genes
If you have a family history of coronary heart disease or factors
predisposing to heart disease such as high cholesterol levels (familial hyperlipidaemia) or high blood pressure, you are more
at risk of developing it yourself. However, it is important that lifestyle are examined to ensure modifications are not required.
• Your ethnic background
If you are black or Asian you are more at risk of
heart disease, although different underlying risk factors are at play for each group. If you are Asian you have a higher risk
of developing diabetes, which is a risk factor for heart disease. If you are black you are more at risk of high blood pressure,
a separate risk factor for both heart disease and heart disease.
• Diabetes
If you have diabetes you are three times more like to develop coronary heart disease. You are also more likely to have silent
ischemia because diabetes can affect the nerves which send pain messages.
Being
overweight and inactive
Both of these are separate risk factors for coronary heart disease and
increase your risk of developing diabetes in middle age. Unfortunately, because in the early stages diabetes often has no
symptoms, many people remain undiagnosed sometimes for years, during which time their arteries may be becoming more damaged.
Of course, other risk factors such as high blood pressure, raised cholesterol levels, smoking, being overweight and
physical inactivity still apply if you have diabetes. In fact, Diabetes appears to be an extra risk - which may possibly amplify
the risk of these other factors.
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