Heart – being the most vital organ of our body, it needs the highest care for its well-being and proper functioning for our health and longevity.  The heart that goes on working nonstop for decades together and at times even crosses a century.  A praiseworthy task indeed!  Preventive and promotive measures for heart care have often been talked and written about under the banner of lifestyle.

Certain disorders of other organs or systems in the body may harmfully affect the heart – like thyroid malfunctions, both under activity (hypothyroidism) or over activity (hyperthyroidism), anemia, malnutrition, and systemic infections, specially tuberculosis which affects the outer covering of the heart – Pericardium (pericarditis).

• Flabby heart muscles disease (Cardiomyopathy) due to excessive alcohol, infection, diabets and other systemic diseases.
• Defective conduction system resulting in disorders of heartbeat and irregular rhythm (Arrhythmia).
• Getting fatigued and weak because of having overworked for long hours under undue pressure, i.e., heart disease due to high blood pressure (Hypertension).
• Clogged coronary arteries that supply fuel (Oxygenated blood) for heart, giving rise to anginal pain and heart attacks.
• Disorders of the valves due to rheumatic fever and rheumatic heart disease.
• Certain holes and blocks present from birth, disturbing and diverting the blood flow in wrong direction. 

On the whole there are four cardinal signals that make us suspect and bring the person with heart disease to see a doctor.  These are 1.Fatigue.  2. Palpitation.  3. Chest Pain.  4. Breathlessness.

As an indication of heart disease, fatigue is a demonstration of poor circulation of oxygenated blood to working muscles. It can happen due to any of the diseases as stated already and the administration of fatigue will, therefore, depend upon taking due care of the disease responsible for it. Once again, non-cardiac causes of fatigue like anemia, hypothyroidism, losses of surplus electrolytes, like sodium and potassium and water due to hot weather or diarrheal diseases must be kept in mind in patients presenting with fatigue and weariness as the sole symptoms.

Giddiness and transitory loss of consciousness or block outs (syncope) are two other indications of significance in the management of heart patients. Patients with heart blocks and severe narrowing of aortic valve may present to the physician with history of syncope or unconsciousness; the management for the former is implanting pacemaker, while for the narrowed aortic valve, the recommended treatment is either balloon valvoplasty or surgery.

It is the rough awareness of one’s heartbeat.  Normally one is not conscious of the incessant beating of heart, even during exercise, but in certain diseased states an uncomfortable awareness takes place and that brings the person to a hospital or a physician for heart check-up.  Causes of palpitation may be non-cardiac also, like anemia, thyrotoxicosis and rarely during pregnancy.  The cardiac causes of palpitation comprise rheumatic heart disease with disruptive or leaky valves, congenital cardiac imperfections and disorders of transmission system of heart, called arrhythmias.  Both fast heartbeat and very slow heartbeat can give increase to palpitation.  Bounced or missing beats or extra but weak heart beats also obvious as a disagreeable feeling in the chest.  Management approach for palpitation is directed towards the reason, like surgical repair or substitute of defective heart valves, ballooning the narrow stenotic valves (valvoplasty), use of a range of potent antiarrhythmic drugs, radiofrequency energy to ablate irregular focus of cardiac contraction, implanting of cardiac pacemakers and Intracardiac Cardioverter  Defibrillators (ICD).  The latter device has helped to prevent recurrence of deadly arrhythmias in survivors of sudden cardiac death, who survived after recovery measures.

One of the many grounds of chest pain is heart trouble. It is the type and explanation of pain that differentiate the cardiac pain from other non-cardiac causes of chest pain. Central chest pain, radiating to either or both arms, more often the left arm, lasting form a few minutes to half an hour or so, linked with a feeling of constriction in chest or heaviness, is often the account of pain due to heart disease. Non-cardiac causes of chest pain comprise cervical spondylosis, peptic ulcer, gall bladder disease, herpes and anemia. The commonest cause of cardiac chest pain (angina and myocardial infarction) is the narrowing of coronary arteries (coronary artery disease) due to the process called atherosclerosis. The aggravating risk factors for this disease are high blood cholesterol, smoking and high blood pressure. Patients having blocked coronary arteries can be successfully treated these days with the help powerful drugs such as nitrates, beta and calcium blocker, ACE (Angiotensin Converting Enzyme) inhibitors and aspirin. Ballooning by angioplasty, atherectomy and using stents (small wire coils) to keep the dilated arteries patent, are some of the non-surgical means to take effective care of pain due to coronary artery disease. These procedures definitely perk up the exercise performance and superiority of life of such patients with coronary disease.  Bypass surgery using veins and artery conduits has transfigured the management strategies for patients with coronary artery disease, giving them not only an angina-free improved excellence of life but also more longevity.  Presently, there is an added help available from TMR (Transmyocardial Laser Revascularization) in those patients who have very poor left ventricular ejection power and not too good graft able arteries.

In the event of breathing difficulty, one is likely to think of lung problems, but breathlessness may occur often, not only during work or exertion but at times also at rest due to diseases of heart. The reason for this indication in heart patients is pooling of blood and raised pressure in the pulmonary circuit (lungs), due to narrowed or leaking valves in the left-sided chambers of the heart either receive blood from the lungs (mitral valve) or eject out blood to the body (aortic valve). Breathlessness also happens due to high blood pressure and it is the cardinal characteristic in patients with heart muscle disease (cardiomyopathy), where it is also usually connected with body swelling of well-known engorged neck veins and enlarged liver. Heart attack and angina may also result in breathing difficulty at rest or during physical exertion. There are potent drugs that relieve circulatory congestion by bringing out extra fluid through urination (diuretics), augmentation of heart action (digitalis), unloading the load on heart on heart by their action on peripheral vasculature (nitrates, calcium channel blockers and AEC inhibitors). Definitive administration includes ballooning of narrowed valves, and repair or replacement or grossly deformed heart valves. Shortening the dimensions of expanded left ventricle due to heart muscle disease by surgery (volume, reduction surgery) and cardiac transplant in patients with end stage heart failure are the other management strategies for very sick cardiac patients where breathlessness is the major symptom. Lung disease and anemia are other major causes of breathlessness, needing specific management approach.

The counteractive and curative management of heart disease depends on the right diagnosis of the above said defect. A cautious listening to the patient’s indications becoming rare these days, detailed physical assessment and a few necessary investigations often help in arriving at the accurate diagnosis. It is once again of enormous importance to observe certain precautionary measures to avoid reappearance of such problems.

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