What is heart disease?
There is, of course, more that one disease that can affect the heart. But when we talk about ‘heart disease’, we are referring to the really common kind – coronary heart disease. This is the result of ‘coronary atherosclerosis’ in which fatty deposits clog up the coronary arteries – the small arteries that supply blood to the heart itself.
These fatty ‘plaques’ restrict blood flow through the coronary arteries, limiting the supply of oxygen to the working heart muscle (myocardium). Angina is a pain arising from heart muscle that isn’t getting enough oxygen. It’s especially likely to be triggered by exertion, such as walking uphill, because the heart needs more oxygen when it works harder. Angina is typically a ‘tight’ or ‘heavy’ pain in the front of the chest, but can sometimes be felt in the arm, jaw or upper abdomen.
Stable angina is predictably provoked by effort and relieved by rest. Unstable angina comes on unpredictably at rest and requires immediate medical treatment to reduce the risk of a heart attack.
A heart attack (myocardial infarction) occurs when the blood supply to an area of heart muscle is completely cut off. Atherosclerosis may have been gradually narrowing the coronary arteries for years – perhaps without causing any symptoms at all – when the sudden formation of a blood clot (coronary thrombosis) completely blocks one of the arteries.
Part of the heart muscle is totally deprived of blood and oxygen, so the pain of a heart attack tends to be more intense and persistent than angina. The affected heart muscle is permanently damaged, but immediate medical treatment can reduce the damage and is often life-saving. So it’s very important to call an ambulance straight away if you suspect a heart attack.
A lot of people make an excellent recovery after a heart attack and return to a normal active life; the small scar in the heart causes no trouble at all. More severe damage may interfere with the heart’s ability to pump efficiently, leading to heart failure. Even then, with modern treatment, heart failure can often be very well controlled.
Drug treatment has revolutionised management of coronary heart disease and can greatly reduce the risk of a future heart attack. In addition to taking any drugs your doctor has prescribed for heart disease, it is extremely important to make the right changes to your diet and lifestyle.
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