Dr. Ajay Sharma:Cardiologist, Lahey Hospital and Medical Center; Southern New Hampshire Medical Center
November 28-Heart is an amazing organ with a pumping action in a wringing fashion and is the result of an organized function of muscle tissue, it’s blood supply (arteries) and an electrical conduction system.
Abnormality of any of these three tissues can lead to catastrophic and fatal events or significant impact on the quality of life. However, ‘blockage’ of coronary arteries are the most common which can lead to heart attack in an acute setting or over a period of time, stable angina leading to chest tightness/ pressure, shortness of breath or decrease in exercise tolerance. Ladies can have atypical symptoms like heartburn or anxiety or even nausea so they should not disregard this as ‘increased acid production’. Heart attacks are one of the leading causes of death world over so this is the foremost. The artery called the ‘widow maker’ provides blood supply to the strongest part of the heart muscle. This is where identifying symptoms and acting on them is paramount. Placing a stent at the right time can prolong life because opening the culprit artery after the heart attack does not provide any benefit. That is why we say ‘time is muscle’.
If heart attack is completed, then part of the heart muscle dies and does not contribute to the pumping function. A normal heart pumps 50-55% of the oxygenated blood that it gets from the lungs. As described, above, if some part is unable to contribute, it leads to congestive heart failure. This can lead to pooling of ‘blood’ in the lungs leading to shortness of breath, inability to lie down flat at night (requiring more pillows to sleep on) or waking up feeling short of breath. Additionally, leg swelling, early satiety or loss of appetite (which indicates fluid build up around intestines), decreased urinary output (congestion of fluid in blood vessels for kidneys). Quality of life is significantly impacted and mortality from this, if not treated appropriately, is very high. If the pumping function is less than 35%, chances of sudden cardiac death because of arrhythmias which lead to no cardiac output, are increased. This is where implanted defibrillators have a role to play.
Electrical conduction system may develop abnormalities which can lead to slow heart beat or disconnect between the upper and lower chambers (conduction block). This may cause dizziness or passing out. Depending up on symptoms or severity of conduction block, this may need to be treated with a pacemaker. There can be increased excitability in the electrical system or short circuiting which can lead to fast heart rate which can cause palpitations. This can be treated with medications and sometimes need a procedure called catheter based ablation. There are arrhythmias like atrial fibrillation and atrial flutter which increase the risk for stroke because of a small pocket called ‘left atrial appendage’ where blood can become stagnant and form a clot. In such instances, the electrical impulse is generated irregularly and the lower chambers beat in that fashion and sometimes very fast even at rest. This, if continued for days/ weeks or months can lead to lower chambers becoming weak and pumping function decreasing to cause congestive heart failure.
There can be inflammation in the layer of tissue around the heart which is called pericarditis or in the heart muscle which is termed myocarditis. They are usually secondary to a viral infection and are transient but need due treatment with anti-inflammatory agents like Ibuprofen or Colchicine.
There are rare conditions like sarcoidosis (autoimmune) and amyloidosis (abnormal protein deposition).