The heart beats up to three billion times in the course of a lifetime – we take this for granted and usually do not realize it. Unfortunately, cardiovascular diseases are the most common cause of death – even if it doesn’t get that bad, a disease of this important organ still usually means a reduction in the quality of life.
Structure and function of the heart
The main task of the heart is to transport blood to all regions of the body. Blood is oxygenated in the lungs and then pumped to all parts of the body through the aorta and many other arteries. The heart‘s beating rate is regulated by fine nerve conduits, and prominent blood vessels – the coronary arteries – supply the heart itself with oxygen and other nutrients. When arteriosclerosis causes calcium and other foreign substances to build up in the body’s veins, the blood flow is disrupted and parts of the body are no longer supplied with sufficient oxygen – this leads to a reduced oxygen supply (ischemia, in the heart this is called angina pectoris) and ultimately to tissue death (infarction). The heart consists mainly of muscle tissue, has four heart chambers and four heart valves. In the right half of the heart, blood from all parts of the body flows into the heart (and then on to the lungs) – in this area, diseases are less frequent and usually not as life-threatening. Most diseases take place on the other, the left side of the heart. This is where the oxygen-rich blood from the lungs arrives and is pumped onward into the body at high pressure. The heart has to build up this pressure 60 to 80 times per minute – it is easy to imagine that a disease has serious consequences and can become life-threatening.
Heart ailments
Normally, we do not perceive the heart activity – the heart independently adapts to different requirements such as physical exertion, anxiety or relaxed rest with the respective heart rate. It becomes all the more disturbing when we become aware of our heart and its work. Heart stuttering or palpitations – an indication of a cardiac arrhythmia – or tightness in the chest, shortness of breath when climbing stairs and heart pain – possibly coronary heart disease – can be typical heart complaints. Sometimes heart disease also starts with feeling less able to bear weight – this can happen with myocarditis, a heart valve defect or heart failure. Many people mistakenly blame the stomach or back for discomfort when they experience pain around the heart – this misses the real cause.
Examination Methods
Anamnesis (inquire about medical history): all complaints can be further narrowed down by asking specific questions. For example, shortness of breath when climbing stairs may occur as early as the second floor but as late as the fifth floor. Onset and duration of pain often indicate the severity of a heart attack. Inspection (looking at), percussion (tapping) and auscultation (listening): a visible sign of heart failure may be foot edema. To a trained physician, the patient’s facial color will also indicate whether valvular heart disease is present. Tapping the chest will determine heart size – but most important, of course, is listening with a stethoscope. The doctor can listen to the workings of the four heart valves on the chest – are there sounds that shouldn’t be, as in a valvular defect, or is the heart beating irregularly? Is the heartbeat loud or quiet (as in pericarditis and pericardial effusion)? ECG: An electrocardiogram (ECG) is done to detect arrhythmias or a decreased oxygen supply. An ECG under stress (e.g., on a trim wheel) can document the shortness of breath described by the patient when climbing stairs. In the case of arrhythmias that occur only sometimes (or at night), a long-term ECG that records cardiac activity over 24 hours is helpful. There is now also the option of sending a current ECG to an emergency unit by phone – this is useful for patients with life-threatening heart problems. Blood tests: If a heart attack is suspected, blood tests for specific cardiac enzymes such as troponin, creatine kinase (CK) and lactate dehydrogenase (LDH) can help confirm the diagnosis. X-ray, ultrasound (cardiac echo): In an X-ray, the heart can be seen as a shadow.Size and shape allow conclusions to be drawn about the heart’s function – calcification on the heart valves is visible there, as is water accumulation in the lungs (in heart failure). Ultrasound examination of the heart shows the thickness of the heart muscle and the function of the valves – if they do not close properly, telltale blood flow is revealed! Modern computed tomography scanners may soon replace cardiac catheters – but there is still no substitute for cardiac catheterization. This relatively new method shows exactly where a narrowing of the coronary arteries is located – even dilatation treatment or stent placement is possible.
Heart disease in children
Unfortunately, there are a wide variety of heart defects that can be congenital and often require immediate surgery. A defect in the cardiac septum is just one of the many heart defects; in this case, a small hole can often be left without surgery because it does not limit heart function.
Heart disease in adults
Heart disease cannot be separated from vascular disease, as shown by coronary artery disease (CAD) with its sequelae of angina and myocardial infarction. CHD is arteriosclerosis of the coronary arteries – since arteriosclerosis is not isolated to the heart but occurs everywhere in arteries, there is also a risk of infarction in other organs. Diseases such as diabetes, high blood pressure or depression increase the risk of heart attack – and men and women show very different symptoms of heart attack. Women are particularly at risk after menopause. Cardiac arrhythmias can have different causes – nerve conduction is also impaired by arteriosclerosis or diabetes. Inflammation of the individual layers of the heart is another group of diseases. Inflammation of the inner lining of the heart (endocarditis) can be caused by a malfunction of the immune system, while inflammation of the heart muscle (myocarditis) occurs in many viral infections – it is particularly feared as a complication of influenza. Pericarditis (inflammation of the outer skin of the heart, the pericardium) can lead to a mechanical restriction of the heart’s movement, with the pericardium forming a rigid corset. Heart valve changes can occur after inflammation of the inner lining of the heart or in myocardial disease. Heart failure is more a description of a condition than a disease – in this case the heart does not manage to transport enough blood. One feels listless and tired or gets short of breath. The extreme case is sudden heart failure, which usually leads to death.
Treatment of heart disease
Since heart disease often occurs along with the “Deadly Quartet,” reducing obesity, medicating a lipid metabolism disorder with a statin, and adjusting diabetes are initial treatment measures. Common cardiac medications include hawthorn extracts, beta-blockers and acetylsalicylic acid – to name a few. If surgery is unavoidable, there is nowadays the option of minimally invasive procedures. To restart cardiac activity in an emergency, a defibrillator is used. Defibrillators are increasingly being installed in public places – but their use by the untrained is controversial. Of course, for each disease there is a special procedure with medication or surgery – more details can be found at the respective disease.
Prevention of heart disease
To prevent CHD and heart attacks, it is best to eat a healthy diet with sufficient magnesium, a conscious approach to cholesterol, plenty of exercise and stress reduction as a matter of course, starting in adolescence. A Mediterranean diet with olive oil and red wine (in the right doses) is particularly recommended. Especially in the case of known heart disease, lifestyle is crucial. Unfortunately, many heart attack patients fall back into “bad”, infarct-promoting behavior patterns after a short time. Even in summer, heart patients should take special care of themselves (keyword: drink plenty!). In winter, sudden cold attacks are highly dangerous. It is best to always carry an emergency ID card with you so that everyone can see what medication the heart patient needs. When traveling, a phrasebook with the most important medical phrases will help, and an assisted vacation can increase travel safety.
