Every day, 16 people die from cardiovascular disease (heart diseases and stroke) in Singapore. Cardiovascular disease accounted for 29.5% of all deaths in 2016. This means that nearly 1 out of 3 deaths in Singapore is due to heart diseases or stroke.
As we approach World Heart Day, we explain some common but often confusing terms connected to cardiovascular disease so you stay in the know.
Speak to a specialist if you’ve concerns about your heart health.
Coronary artery disease
Coronary artery disease (CAD), a term often used interchangeably with coronary heart disease (CHD), develops when the blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries), become damaged or diseased.
Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury. This process is also known as atherosclerosis. This leads to narrowing of the blood vessel and reduced blood supply to the portion of the heart that it supplies. If the surface of the plaque breaks or ruptures, blood cells (platelets) will clump at the site to try to repair the artery. This clump can sometimes critically block the artery, leading to a heart attack.
Your risk of CAD increases with age, if you are male, a woman after menopause or if you have a family history of the disease. Lifestyle habits like smoking or physical inactivity are also risk factors. But there's plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact.
See your doctor if you have shortness of breath with exertion or feel tightness or pressure in your chest. This pain, known as angina, usually occurs in the middle or left of the chest and is often triggered by physical or emotional stress. This pain might also appear in the neck or arm. In women, the elderly or people with diabetes, these symptoms may not be so classical and may appear on the right side of the chest or in the back. Sometimes there may only be mild breathlessness or detected only upon doing cardiac tests.
Your cardiologist can unblock your arteries through a minimally invasive procedure called percutaneous transluminal coronary angioplasty (PTCA). They will insert a catheter into your artery in your wrist or groin and guide it through the blood vessel to your coronary arteries where a dye is released. Using an x-ray, they can see where the blockage is and insert a balloon device, which is inflated for a few seconds to compress the blockage. This is repeated for each blockage found. A stent may be inserted to keep the blood vessel open.
A common surgery performed to treat CAD is coronary artery bypass graft (CABG) surgery, which is advised for selected groups of patients with significant narrowings and blockages of the heart arteries not amenable to PTCA. It creates new routes around narrowed and blocked arteries, allowing blood flow to deliver oxygen and nutrients to the heart muscle.
Heart attack vs heart failure
Heart failure is characterised by the heart’s inability to pump an adequate supply of blood to the body and maintain bodily functions. Heart failure is a condition or a collection of symptoms that manifest as a result of a weakened or ‘stiff’ heart.
A heart attack, also called myocardial infarction, is one of the causes of heart failure. During a heart attack, the blood supply that normally nourishes the heart with oxygen is suddenly cut off and the heart muscle begins to die, thereby weakening the heart. The amount of time it takes before receiving treatment and the area of damage will determine the long-term effects of an attack on your heart. A heart attack can also affect your heart valves and cause leaks.
Warning signs include:
- chest pain
- left arm or jaw pain
- cold sweats
- troubled breathing
One of the most common causes of a heart attack is CAD. When a cholesterol plaque ruptures, the ensuing platelet clump can lead to a sudden critical narrowing of the blood vessel, causing a heart attack. Other less common causes of heart attack include blood clots, a torn blood vessel or blood vessel spasm.
While a heart attack is sudden, heart failure can be either an acute (short-term) condition that you can recover from, or a chronic (ongoing) condition. In chronic heart failure, symptoms are often progressive and may be associated with occasional episodes of sudden worsening (acute decompensation). The vast majority of heart failure cases are chronic.
Heart failure is a serious medical condition that requires timely treatment to control your symptoms, increase your chances of long-term recovery and reduce complications. Call your doctor if you are having any of these symptoms:
- excessive fatigue
- sudden weight gain
- a loss of appetite
- persistent coughing
- irregular pulse
- heart palpitations
- abdominal swelling
- shortness of breath
- leg and ankle swelling
- protruding neck veins
Heart failure is most often related to another disease or illness. The most common cause of heart failure is CAD. Conditions that may increase your risk for developing heart failure include congenital heart defects, a heart attack (as mentioned above), irregular heart rhythms, high blood pressure, various diseases such as anaemia, hypothyroidism, hyperthyroidism and emphysema, as well as medications, and drug and alcohol misuse.
Heart failure can happen to anyone. You should take life-long preventive measures to stay healthy. However, you have a higher risk if you are male, overweight, and if you smoke, eat foods high in fat or cholesterol, or have a sedentary lifestyle.
Contact your doctor if you have new and unexplained symptoms that may indicate a problem with your heart. Early treatment is key in preventing the most serious cases of heart failure.
A cardiac arrest occurs suddenly and often without warning. It happens when the heart’s ‘electrical system’ malfunctions and stops blood flow from the heart. The most common cause of cardiac arrest is ventricular fibrillation – causing the heart to beat in a rapid and erratic rhythm.
When the heart cannot pump blood to the body’s organs, the person loses consciousness and has no pulse. Minutes later, the victim may die if they do not receive treatment.
Symptoms are immediate and include:
- sudden collapse
- no breathing
- loss of pulse
- loss of consciousness
Compare the difference between a heart attack and a cardiac arrest.
Call for the emergency ambulance service if you witness anyone with a cardiac arrest. Administer immediate cardiopulmonary resuscitation (CPR) if you are trained to do so.
Hypertensive heart disease
Hypertensive heart disease refers to heart problems that occur because of high blood pressure over a long time. The pressure inside the blood vessels is too high and as a result, the heart must pump harder. Over time, this causes the heart muscle to thicken. Sometimes, the muscle can be so thick it does not get enough oxygen. High blood pressure also leads to thickening of the blood vessel walls. When combined with cholesterol deposits in the blood vessels, the risk of heart attack and stroke increases.
Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems and chronic kidney disease. If your blood pressure is high, you need to lower it and keep it under control. Have your blood pressure checked every year or as often as advised by your doctor.
Congenital heart disease
Congenital heart disease, or a congenital heart defect, is a heart abnormality present at birth, where the heart doesn’t pump blood as efficiently as it should. The defects can affect the heart walls, valves or blood vessels. They can range from simple conditions that don’t cause symptoms to complex problems that cause severe, life-threatening symptoms.
Congenital heart disease may be hereditary or caused by issues with the mother’s health during pregnancy, either from taking certain prescription drugs during pregnancy, using alcohol or illicit drugs during pregnancy, or contracting a viral infection during the first trimester of pregnancy.
The condition is usually detected after birth, but in some cases may not be diagnosed into adulthood. Once diagnosed, it is important to continue seeing your doctor for follow-up care. This can help you maintain an active, productive life and help reduce your risk for serious complications, such as heart infections, heart failure and stroke.
Although chest pain is often associated with heart disease, many people with heart disease say they experience a vague discomfort that isn't necessarily identified as pain. In general, the chest discomfort is described as one or more of the following and you should seek medical help if you experience:
- pressure, fullness, burning or tightness in your chest
- crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms
- pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity
- shortness of breath
- cold sweats
- dizziness or weakness
- nausea or vomiting
Chest pain that occurs suddenly, is severe and is persistent, may be caused by a heart attack. Mild chest pain that occurs on exertion and relieved by rest may be caused by a gradual build-up of cholesterol plaque over time. The latter is also known as ‘stable angina’.
Go to the A&E department if your chest pain does not go away within 5 minutes or if the intensity is severe and associated with dizziness or loss of consciousness.
Chest pain may sometimes be caused by diseases other than heart disease. Conditions such as gastroesophageal reflux disease (GERD), stomach ulcer disease, musculoskeletal pain and certain lung conditions can also result in chest pain symptoms. It is important to consult your doctor to evaluate the most likely cause of your chest pain.
Arrhythmia (Irregular heartbeat)
Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly. They may feel like a fluttering or racing heart and may be harmless. Most arrhythmias can be treated with medication. However, some heart arrhythmias may cause life-threatening symptoms.
To regulate your heart beat, your doctor may recommend installing a pacemaker, a small device that's placed under the skin in your chest, to help control your heartbeat.
A heart murmur is a sound that is heard due to turbulent blood flow within the heart. While most heart murmurs are functional and are no cause for alarm, a heart murmur can be caused by valvular heart disease or congenital heart disease. It is the turbulent blood flow across a diseased valve that causes the abnormal sound. An increased blood flow across the valve, as in the cases of anaemia and hyperthyroidism, can also cause heart murmur, as can a hole in the wall of the heart.
It is important to have regular physical exams to detect any abnormal heart sounds. If a murmur is heard, further evaluation will be required to determine why the murmur is present, if medical treatment is needed, which valve is involved, and the severity of the problem.
Cerebrovascular disease refers to a group of conditions that affect the blood vessels and blood supply to the brain and can lead to a stroke or brain haemorrhage. If a blockage, malformation, or haemorrhage prevents the brain cells from getting enough oxygen, brain damage can result.
The signs and symptoms of cerebrovascular disease or a cerebrovascular attack depend on where the blockage or damage occurs, and how much cerebral tissue is affected. Different parts of the brain affected can lead to different symptoms or deficits. Common signs and symptoms include:
- a severe and sudden headache
- paralysis of one side (hemiplegia)
- weakness on one side (hemiparesis)
- numbness on one side
- drooping of one side of the face
- difficulty communicating, including slurred speech
- loss of half of vision
- loss of balance
- loss of consciousness
Individuals with heart arrhythmia should ask their doctor if they should be taking a blood thinner to prevent strokes. Stroke and other cerebrovascular events can be fatal, but with rapid medical attention, a full or partial recovery is possible. If you have cerebrovascular disease, you should follow healthy lifestyle tips and your doctor's instructions to reduce the chance of an attack.
Maintaining your vascular heath
You can reduce your risk of heart disease and stroke by following these healthy lifestyle tips:
- Quit smoking
- Control blood pressure and cholesterol levels
- Reduce the risk of developing diabetes
- Maintain a healthy weight
- Manage stress
- Follow a healthy diet
- Exercise regularly
Going for regular heart screening is also an effective way to identify hidden heart risks early. To arrange for one, make an appointment with a specialist.
Article reviewed by Dr Lim Choon Pin, cardiologist at Mount Elizabeth Novena Hospital
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