Chest pain can occur as a result of many problems, but those associated with the heart and lungs are the most severe and can be life threatening. New or unexplained chest pain lasting for more than a few minutes demands immediate medical help, as it could be the sign of something serious. In addition, chest pain associated with other symptoms, such as sweating, nausea, vomiting, shortness of breath, dizziness, light-headedness, irregular pulse and pain that spreads from the chest to shoulder, arms, neck, or jaw, is an emergency situation.
At the emergency department, your doctor will try to determine the cause of your chest pain by reviewing your medical history, performing a thorough physical exam, and order various diagnostic tests such as electrocardiogram, blood tests, chest X-ray, echocardiogram, CT scan, MRI, stress tests and angiogram.
Treatment will depend on the underlying cause of the chest pain. You may be given IV fluids, oxygen and medication to dissolve any blood clots that could be causing the chest pain. Your ER doctor may perform cardiac catheterization, where a flexible tube is guided into the heart through a blood vessel present in the groin or wrist, to open a blocked artery. You also may be transferred to the hospital for further treatment.
Palpitations & Dizziness
Angina & Myocardial Infarction
Arrhythmia is a disorder characterized by abnormal heart beat such as beating too fast, too slow or irregularly. During arrhythmia, as the heart is not able to pump enough blood to the body, it can lead to organ dysfunction or damage. Most arrhythmias are harmless; however, some are more serious and life-threatening.
Physiology of the heartbeat
The heart is a strong, muscular pump that pumps blood across the body. When your heart beats, the electrical impulses that coordinate your heartbeats usually follow a precise pathway through the heart. Any disruption in these impulses can result in arrhythmia.
Types of arrhythmias
There are different types of arrhythmias. Arrhythmias are classified by where they originate (atria or ventricles) and the speed of heart rate.
- Atrial fibrillation: irregular contraction of upper heart chambers
- Bradycardia: slow heart beat
- Conduction disorders: abnormal heart beat
- Premature contraction: early heart beat
- Tachycardia: fast heart beat
- Ventricular fibrillation: irregular contraction of lower heart chambers
A heart attack or other conditions such as high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland, and congenital heart defects that damages the heart's electrical system can cause arrhythmias.
Smoking, excess consumption of caffeine or alcohol, high stress, and certain medications can also lead to arrhythmias.
Symptoms of arrhythmia can range from mild to severe. Some of these symptoms can go unnoticed, but those that show up include:
- Chest pain
- Light-headedness, dizziness or fainting
- Shortness of breath
To diagnose a heart arrhythmia, your doctor will collect detailed information about your family's medical history, medications, health problems, and health habits. Your doctor may also carry out a physical examination, during which the doctor will listen to your heart and check your pulse to measure your heart rhythm and heart rate.
Your doctor may order other tests such as:
- Electrocardiogram (ECG): a painless test that detects and records your heart's electrical activity
- Holter monitor: a portable machine that records your hearts activity over a 24-hour period
- Coronary angiography: a procedure which uses a special dye and X-rays to view the pattern of flow of blood to the heart
- Chest x-ray to check for heart enlargement
- Blood tests to measure blood levels of potassium and thyroid hormone
- Echocardiography to view the size, structure and movement of the heart
- Stress test to determine irregular heart rhythms during exercise
- Electrophysiology study (EPS), where wire electrodes are placed in the heart to measure the electrical activity
Arrhythmia can be treated with medications, an implantable cardioverter defibrillator (ICD) or pacemaker, or sometimes surgery to restore a normal heart beat.
Catheter ablation: It is a procedure that uses radiofrequency energy to destroy abnormal heart tissue that is causing your heart rhythm problems.
Valvular Heart Disease
The heart is an organ that pumps oxygen-rich blood to every cell in the body. The human heart is divided into four chambers, two superior atria and two inferior ventricles that are connected by four valves (mitral, tricuspid, aortic, and pulmonary). The heart valves permit the unidirectional flow of blood between the chambers of the heart.
Valvular heart disease (VHD) occurs when your heart valves do not function properly. Any damage or defect of the valve causes an abnormal blood flow through the heart. Types of heart valve disease include:
- Valvular stenosis is the narrowing of any of the heart valves causing obstruction of blood flow.
- Valvular regurgitation or incompetence, also known as leaky valve is a condition in which the valves do not close completely and allow the blood to leak backwards into the heart.
The major causes of valvular heart disease include:
- Congenital heart disease (abnormal valves present at birth)
- Rheumatic fever
- Heart muscle disease (cardiomyopathy)
- Heart attack
- Advanced age
- Infection of the heart valves (endocarditis)
- High blood pressure
- Radiation therapy used to treat cancer
The symptoms of a valvular heart disease include:
- Shortness of breath
- Weakness or dizziness
- Chest pain and discomfort
- Heart palpitations
- Swelling of ankles, feet, or abdomen
- Sudden weight gain
The diagnosis of VHD is based on your symptoms, medical history, and physical examination.
The examination includes inspection, palpation, and auscultation of the heart. Your doctor listens to your heart sounds using a stethoscope. A murmur is an abnormal heart sound heard when the blood flows through a stenotic or leaky valve. Your doctor may order a few diagnostic tests such as:
- Echocardiography is an imaging test that uses sound waves to examine the heart anatomy and its functions.
- Electrocardiogram (ECG or EKG) is a test that records the electrical activity of the heart.
- Cardiac or treadmill stress test is used to determine the effects of exercise on the heart. It provides your doctor with information about your blood pressure, heart rate, and respiratory rate.
- Cardiac catheterization or Angiography is a diagnostic test performed to assess the heart and blood vessel conditions. A thin flexible catheter is placed through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the heart blood vessel to be viewed, a contrast material is injected and X-ray images are taken.
The treatment of valvular heart disease depends on the cause and severity of the symptoms.
- Lifestyle modifications such as eating a healthy diet low in salt and fat, exercising regularly, maintaining a healthy weight, quitting smoking, and managing stress will help slow the progression of your heart disease.
- Your doctor may prescribe medications to improve your cardiac health.
- Surgery is indicated when conservative treatment measures fail to relieve cardiac symptoms. The surgical options depend on the patient's age and health status and may include:
-Percutaneous balloon valvotomy is a procedure in which a balloon is placed across the stenosed valve and inflated. This results in widening of the valve and improved blood flow.
-Minimally invasive heart valve surgeries to repair or replace the damaged heart valves are of two types: Valve Repair: This is often performed for valves with mild to moderate damage.
Valve Replacement: This is performed for seriously damaged valves. Here the diseased valve is removed and replaced with a new valve. The replacement valves can either be biological or mechanical valves.
The need for heart valve repair or replacement depends on many factors, such as the type, cause, and severity of the valve disease, the symptoms, and general overall health of the patient. Valvular surgery helps to reduce the symptoms and improve quality of life.
Hypertrophic & Dilated Cardiomyopathy
High Blood Pressure (Hypertension)
Hypertension is one of the most prevalent diseases throughout the world. It is considered as one of the major causes for development of cardiovascular diseases.
Hypertension is characterized by a high blood pressure (BP).
BP is the force existing in the walls of arteries due to blood flow.
- The normal BP is 120/80mmHg (120 denotes systolic blood pressure and 80 denotes diastolic blood pressure).
- If BP is more than 120/80mmHg, but below 140/90mmHg, then that condition is called as pre-hypertension.
- If BP is more than 140/90mmHg, then that condition is considered as hypertension.
Causes of hypertension
Based on the cause, hypertension can be classified as either essential (unknown cause) or secondary (specific cause).
The main causes of hypertension are:
- High intake of sodium (>1500mg/day)
- Older age and stress
- Smoking and alcohol consumption
- Adrenal and thyroid gland problems
- Chronic kidney disease
- Increased cholesterol
- Vitamin D deficiency
- Drug use (e.g., Steroids)
In general, hypertensive patients may not have any symptoms. But, some patients might complain severe headache, nausea or vomiting, confusion, changes in your vision, etc.
Hypertension is diagnosed by measuring the persistent elevation of blood pressure.
Treatment of hypertension includes:
- Life style modifications
- Reduce the salt intake
- Maintain normal body weight
- Avoid stress
- Avoid smoking and drinking alcohol
- Do exercise
- Consume a diet rich in fruits, vegetables, and with low fat
If hypertension is not controlled even after modifying life style, then drug are recommended to reduce blood pressure. There are different drugs available to reduce blood pressure. According to the requirement, physician will prescribe either single drug or a combination of two or more drugs.
The common drugs used to reduce blood pressure are diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors.
Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. As a result, the kidneys start retaining fluid in the body. Congestion occurs when the retained fluid builds up in the organs of the body and the condition is described as congestive heart failure.
In most cases, heart failure is a chronic, long-standing and on-going condition but it can develop suddenly. A person may experience heart failure because of structural changes in walls of heart chambers or improper functioning of valves.
Any factor that increases the workload of heart muscles is the risk factor for heart failure. Some of these causes include:
- Coronary heart disease: It is a condition of narrowing of arteries because of plaque build-up on vessel walls which reduce the blood supply to the heart muscle.
- History of heart attack
- Uncontrolled High blood pressure
- Uncontrolled diabetes
Other causes of heart failure include valvular heart disease, such as aortic stenosis, congenital heart defects, cardiomyopathy - disease of the heart muscle, lung diseases, arrhythmias (irregular heartbeat) and chronic alcoholism.
The "failing" heart continues to work but not as efficiently as it should. People with heart failure cannot exert themselves because they experience shortness of breath and get tired easily.
Common symptoms of heart failure are:
- Breathlessness and difficulty in breathing
- Weight gain because of retention of fluids
- Inability to lie down flat on bed because of fluid retention in the lungs
- Swelling in the legs (oedema)
Your doctor will diagnose heart failure based on your medical history alone but may also ask you to undergo a series of diagnostic tests.
- Medical history: Medical history includes physical examination, questions regarding your symptoms, personal history and family history of any heart disease.
- Chest X-ray: A chest X-ray can show if your heart is enlarged and if you have fluid accumulation in and around your lungs.
- Electrocardiogram: Electrocardiogram is done to measure the electrical activity of your heart. It provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart.
- Echocardiogram: Echocardiogram is a test that uses sound waves to create a moving picture of the heart. These ultrasound images help to identify abnormalities in the heart muscle, valves and fluid that may surround the heart.
- Nuclear heart scans: This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye is injected into your bloodstream and a special camera is used to see the dye and find out areas of reduced blood flow.
- Angiography (Cardiac Catheterization): Angiography is a test that enables your doctor to take X-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and X-ray images are taken.
The management of heart failure includes general management, medications and surgery.
- Reduction of physical activity reduces demand on the heart
- Dietary modifications - low salt and low-fat diet
- Losing weight if you are overweight
- Quitting smoking
- Alcohol restriction
The medications that may be prescribed include:
- Diuretics - These agents promote salt and water excretion by the kidneys. This reduces the workload of the heart and symptoms of fluid retention. They help relieve shortness of breath and leg swelling.
- Vasodilating agents - They dilate the blood vessels and decrease the work load on the heart.
- Digoxin - Increases the ability of the heart muscle to contract properly and prevent heart arrhythmias.
- Cardio selective beta blockers - These agents slow down the heart rate, reduce the heart's need for oxygen and improve the supply of blood to the heart muscle.
Left ventricular assist device: A mechanical heart pump called a left ventricular assist device (LVAD) which helps to pump blood from the heart to the rest of the body can be implanted until you have surgery or also as a long-term treatment.
Cardiac transplantation: Cardiac transplantation is the process of replacing the failing heart and with a healthy donor heart. The donor heart is usually collected from a person who has been declared clinically brain dead. It is recommended in younger patients with severe heart failure and life expectancy less than 6 months.