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Angina

Angina, also known as “chest pain” or “chest discomfort,” is a medical condition that occurs when the heart does not receive enough oxygen. Oxygen is carried in the blood, which is delivered to the heart muscle through the three coronary arteries. When your heart beats faster such as during exercise, it needs more oxygen. If the coronary arteries are partially blocked ,and cannot deliver enough blood, the heart muscle begins to hurt. Although more serious, it is not entirely unlike when your other muscles hurt during a strenuous workout. Angina in some cases (for example in people with diabetes) can have an “atypical presentation” that does not include pain or discomfort.

Angina is often perceived as a “chest discomfort” that comes on gradually with exercise and resolves with rest. When the coronary arteries are partially blocked angina can be induced by anything that makes the heart beat faster such as exercise, sex, emotional stress, and party drugs – particularly cocaine. The difference between angina and a heart attack is the duration of the symptoms; angina should not last more than 20-30 minutes. If the angina symptoms are sustained for more than 30 minutes, with no relief, the person may be experiencing a heart attack. The blood supply to the heart is critical, so this can result in permanent damage. A heart attack is a medical emergency and requires urgent medical attention.

Along with the chest pain or discomfort, people with angina may also experience other symptoms such as nausea, indigestion, light-headedness, feeling clammy, excessive sweating, and fatigue.

A physician is the only person that can confirm the diagnosis of angina after completing some tests. These tests often include blood tests; an electrocardiogram, done by placing wires on your chest; a cardiac stress test, when you run on a treadmill while your heart is monitored; and an echocardiogram, an ultrasound of your heart. Your physician may consider performing another test called cardiac catheterization. During cardiac catheterization, a heart specialist (a cardiologist) introduces a tiny “tube” into one of the arteries of your groin, and then threads the tube up to your heart in order to look inside the arteries delivering blood to the heart muscle (the coronary arteries). This way the specialist can identify areas within the arteries that may be clogged.

The treatment of angina involves medicine and life-style changes. If you smoke it is important that you quit; your doctor can help you with this. A low fat diet is also important, with less red meat and more vegetables and fruits. You can also improve overall blood circulation through regular physical activity, and consider losing weight if you are overweight.

Medicines used to treat angina include those to decrease further complications on your heart and to manage the “chest pain” when it occurs. Your doctor may give you a medication called nitroglycerin. You can use this when you have chest pain due to angina to help open up your heart arteries and improve the flow of blood to the heart muscle. Another type of medication, called beta-blockers, is taken every day and helps reduce the stress on your heart.  Keep in mind that if you have other medical conditions that could contribute to angina they also need to be treated properly; particularly elevated cholesterol, high blood pressure, and diabetes.

It is important to recognize that angina is a symptom of a heart condition that requires assessment by your physician or a cardiologist. The symptoms can vary between people, although “chest pain or discomfort” is the most common symptom.

If you suffer from angina you should talk to your doctor before starting any physical activity program. Recreational drugs (including “poppers,” or inhaled nitrates) and some prescription medications like Sildenafil (Viagra) and Tadalafil (Cialis) can worsen the severity of angina. Again, talk to your doctor before using them.

People with angina can feel that they must limit activity, avoiding exercise and sex, so as not to stress their heart. However, experience from different cardiac centres suggests that supervised and planned physical activity (Cardiac Rehabilitation) improves a patient’s quality of life in cases of severe cardiac disease.

If you suspect you may have angina speak to your doctor and have a proper assessment to identify your risk factors and plan your management accordingly. This will decrease the possibility of further cardiac complications such as heart attack or heart failure.

Further information could be found in the Heart and Stroke Foundation.

Arrhythmias

For most people, the heart beats regularly with a steady rhythm between 60 and 80 times per minute. With physical activity or when anxious, the heart will beat faster; with rest and during sleep, the heart beats slower. An arrhythmia is when the heart beats abnormally. There are many types of arrhythmias. Some involve the heart beating faster than is needed, and some the heart beats too slowly. In other arrhythmias the heart beats irregularly, with some beats in quick succession followed by short pauses. Some arrhythmias are sustained, some come and go. Some arrhythmias are not serious, some are life threatening.

There are many different causes for arrhythmias. Some are caused by heart disease and damage to the heart, some are genetic, and some can be caused by medication. Cocaine, amphetamines, and excessive caffeine intake can also trigger arrhythmias.

Some arrhythmias have no symptoms while others are quite serious. If the heart is beating too slowly it will not be able to deliver enough blood to the organs including the brain. This can cause feelings of fatigue, dizziness, or lightheadedness, and may cause people to faint. When the heart beats too fast people may experience chest pain, lightheadedness, and shortness of breath. They may also experience palpitations, or feelings of a “racing heart.”

Arrhythmias can be diagnosed in different ways. Your doctor will examine you, listen to your heart sounds with a stethoscope, and feel your pulse. He or she will obtain an electrocardiogram, or ECG. This is done by placing wires on your chest and recording the electrical activity of your heart on a piece of paper. Particularly if the arrhythmia comes and goes, your doctor may request a Holter monitor. In this case, similar wires are placed on your chest as for an ECG, but you wear them for a full 24 hours. Over this time, the monitor records your heart’s activity that can then be examined by your doctor.

Treatments for arrhythmias differ depending on the type of arrhythmia, the severity, and how often it happens. Most people with arrhythmias live normal lives. Some people whose heart beats too slowly need pacemakers. For people whose heart beats too fast, there are a number of medications that can slow and control the heart. Occasionally, surgery may be required to correct an underlying problem that causes the heart to beat abnormally.

Heart attack

Heart attack refers to a critical loss of blood flow to the heart muscle resulting in part of the muscle dying. The heart is essentially a four-chamber pump composed of muscle that contracts to circulate the blood. Like all active muscles, the heart needs a steady supply of oxygen delivered in the blood. Blood is delivered to the muscular walls of the heart by three arteries known as the coronary arteries. If there is hardening of the arteries (atherosclerosis) they can become narrow and less blood can flow to the heart muscle. During exercise, as the heart beats faster, the narrowed arteries cannot deliver enough oxygenated blood and the heart muscle begins to hurt, this is called angina. If one of the arteries is blocked completely no blood will get to the portion of the heart muscle fed by that artery. Without oxygen from the blood that portion of the heart muscle will die

A heart attack is perceived as pain and discomfort in the chest. The pain may feel tight or heavy, and is often described as “an elephant sitting on my chest.” The pain may also extend down one arm, usually the left, or up into the jaw. Unlike angina, resting will not make the pain subside. Along with chest pain, people having a heart attack may also experience other symptoms such as nausea, indigestion, shortness of breath, light-headedness, feeling clammy, or excessive sweating.

A physician is the only person who can diagnose a heart attack. The diagnosis is based on symptoms, a blood test, and an electrocardiogram (ECG; done by placing wires on your chest).

A heart attack is a medical emergency and requires immediate attention; as time passes more of the heart muscle will die. If you think someone is having a heart attack, call 911 immediately. Check the person for a pulse, either at the wrist or at the neck next to the windpipe. If you cannot feel a pulse, start chest compressions (CPR) and consider using a defibrillator if one is available.

Treatment of a heart attack begins immediately with nitroglycerin (to try and open the arteries), oxygen, and aspirin. In the emergency department doctors may give special “clot busting” medications to dissolve the blockage in the artery and restore blood flow to the heart muscle. Patients may also be taken directly for cardiac catheterization. During cardiac catheterization a heart specialist (a cardiologist) introduces a tiny “tube” into one of the arteries in the groin, and then threads the tube up to the coronary arteries in the heart. By doing this, the cardiologist is able to physically open the blocked artery.

A healthy lifestyle is the first step in helping to prevent a heart attack. If you smoke, it is important that you quit. Your doctor can help you with this. A low fat diet is also important, with less red meat and more vegetables and fruits. You can also improve overall blood circulation through regular physical activity.

High Cholesterol

Cholesterol is a form of fat that is contained in the food we eat, and is also made by our bodies. Our bodies require some cholesterol in order to synthesize hormones and other compounds, like bile, that help us digest our food. Cholesterol is carried in the blood in small packages called lipoproteins. There are two main types of cholesterol-lipoprotein packages, low-density lipoproteins (LDL), referred to as “bad cholesterol;” and high-density lipoproteins (HDL), referred to as “good cholesterol.” When there is too much LDL in your blood, these packages will get deposited in the walls of your arteries. This causes atherosclerosis, or hardening of the arteries. HDL is considered good cholesterol, as it more efficiently delivers cholesterol to your liver, where it is used to make bile.

High cholesterol means having too much cholesterol in your blood. The more LDL you have, the greater your risk of developing heart disease. The more HDL you have, the lower your risk of developing heart disease. Some people have high cholesterol because their bodies make too much of it. For most people though, high cholesterol is the result of a diet rich in saturated and trans fats. The average person should aim for a total cholesterol level less than 5.2 mmol/L; with an LDL less than 3.5 mmol/L, and an HDL greater than 1.0 mmol/L. If you have additional risk factors for heart disease, such as diabetes or smoking, your total cholesterol and LDL targets may be lower.

High cholesterol has no symptoms, so it is important to have your cholesterol checked periodically. The amount of cholesterol in your blood is determined through a blood test. The best time to have your cholesterol measured is after fasting (on an empty stomach), such as first thing in the morning before you have coffee or anything to eat.

High cholesterol is treated with medication. There are several different medication options, so talk to your doctor about which might be best for you. The two most common medications are a group called “statins,” which prevent your body from making cholesterol; and ezetimibe, which prevents your intestines from absorbing the cholesterol you eat.

You may be able to avoid developing high cholesterol, or reverse it without medication, through diet and exercise. Reducing the amount of red meat and dairy products in your diet and increasing whole-grains, vegetables, and fruits can make a significant difference. Regular exercise can also help lower your cholesterol.

High blood pressure

The medical term for high blood pressure is hypertension. It is a measure of how much pressure your blood is putting on your blood vessels. It is kind of like the water pressure in your tap; if the pressure is too low not enough blood will reach your organs, if the pressure is too high it will damage your blood vessels. The damage caused by prolonged hypertension can lead to heart attack, stroke, and kidney failure.

Blood pressure is composed of two numbers; the higher systolic pressure, and the lower diastolic pressure. When your heart beats, it contracts to pump blood through the arteries. This creates a pressure wave and is measured as the higher systolic pressure. When the heart relaxes, the pressure in the arteries temporarily drops. This is measured as the lower diastolic pressure. You can feel these pressure waves as your pulse. A normal systolic pressure should be around 100-120, and diastolic pressure should be around 70-80. Systolic pressures between 121-139, and diastolic pressures between 81-90 should be closely monitored. Systolic pressures of 140 and above or diastolic pressures of 90 and above are classified as hypertension and require treatment.

High blood pressure usually has no symptoms, and so can persist undetected for some time. Even without symptoms, high blood pressure can damage your arteries. Thus it is important to have your blood pressure checked from time to time. Some people with very high blood pressure may develop headaches or shortness of breath.

Blood pressure is easy to measure using a blood pressure cuff. This can be done by a nurse or a doctor; many pharmacies also have automated blood pressure cuffs. Blood pressure varies over the time of day and with activity level, it is best to measure your blood pressure on several occasions to detect a consistent pattern. You should avoid measuring your blood pressure when you are stressed, anxious, or pressed for time.

High blood pressure is treated with medication. There are several different medication options, so talk to your doctor about which might be best for you.

If you have high blood pressure there may also be a number of things you can do to lower it naturally. Physical inactivity and being overweight can lead to hypertension. Too much sodium in your diet, nicotine in cigarette smoke, alcohol, and feeling stressed and anxious also cause high blood pressure. Some party drugs, like cocaine and amphetamines, cause serious increases in blood pressure. Thus a healthy lifestyle is your best defense against high blood pressure. Exercise regularly and eat a diet low in fat and sodium. Consider losing weight if that is appropriate. If you smoke, quit. And make sure you have some down time to relax that does not involve alcohol or party drugs.