Awakening at night short of breath may also be warning of heart
difficulties. This type of night breathlessness often takes the form of
feeling of suffocation or a choking sensation. Shortness of breath may also
indicate other disorders; some of these are described more fully in the
article on BREATHLESSNESS.
Chest Pain (Angina Pectoris)
This type of pain, usually over the heart or in the mid-chest, may follow
some excitement, a heavy meal, or exertion. It may not last more than a
minute or two, and may fade when the person rests or stands still. Such
pain may frequently be confused with similar symptoms arising from gas
pains or indigestion, but only a physician should diagnose the complaint.
Self-diagnosis can be dangerous.
Swelling of the Ankles and Feet
Deterioration of the heart’s pumping efficiency, or heart failure, can
throw the blood circulation odd balance and cause fluid to collect in the
tissues (edema). Swelling may be caused by varicose veins or by standing
for long periods of time, but puffiness of a different type which may
interfere with putting on shoes, or which can be deeply indented by
pressure with a finger, should be checked with a doctor.
Kinds of Heart Disease
The diseases affecting the heart and blood vessels range from defects
present at birth to damage of the organs caused by other diseases or
injuries. They include congenital, syphilitic, and rheumatic heart disease;
bacterial endocarditis, coronary insufficiency, coronary thrombosis, heart
failure, and related disorders.
Congenital Heart Defects
Between 30000 and 40000 children with one or more heart defects are born
annually in the USA. A quite common defect is the tetralogy of Fallot,
sometimes inaccurately called Blue Baby. Another defect consists of passage
between the aorta and pulmonary artery which normally closes right after
birth. There may be an opening between the ventricles, the two pumping
chambers of the heart (ventricular septal defect). Defective valves
affecting the flow of blood to and from the heart may also be present.
A rarer congenital condition is transposition of the great vessels. In this
defect, the position of the chief blood vessels of the heart is reversed.
The aorta, the chief artery in the body, rises from the right ventricle
instead of the left, while the pulmonary artery, which carries blood to the
lungs, emerges from the left ventricle rather than from the right. The
result of this circulatory confusion is that dark oxygen-poor blood
returning from the body to the right side of the heart is pumped back into
the general circulation instead of being transported to the lungs.
Meanwhile, red, oxygen-rich blood flows aimlessly to and from the lungs.
Both the tetralogy of Fallot and the transposition of the great vessels can
be corrected in some instances by special surgery.
The condition in which the passage from the aorta to the pulmonary artery
fails to close after birth may occur by itself, without associated defects.
This defect forces the left ventricle to overwork. Another congenital
defect results when the foramen ovale, a window between the auricles (upper
chambers of the heart) fails to close completely after birth. When an
opening remains between the auricles, some of the oxygen-rich blood from
the left auricle passes into the right auricle and travels back through the
lungs without being first transported through the body. Another heart
defect, coarctation of the aorta, results when the portion of the aorta is
unusually narrow. In many cases – depending on the severity of the defect
and the physical condition of the patient- these congenital conditions can
be treated by surgery.
Syphilitic Heart Disease
Years after syphilis is contracted, the disease can damage the aorta, as
well as injure the aortic valve. The walls of the aorta are invaded by the
syphilis germs, and eventually become weakened. The aorta gradually dilates
forming an ANEURYSM which may rupture.
Rheumatic Heart Disease
This disease most commonly starts between the age of 5 and 19 but can occur
at any age. It is the result of rheumatic fever, a combination of a
streptococcal infection and an allergic sensitivity to streptococcal germs.
It is responsible for most heart disease in individuals under the age of
20.
Early indications of rheumatic fever may be a state of fatigue, poor
appetite, failure to gain weight, paleness, and anemia.
It is estimated that 50 percent of those who are diagnosed in adulthood as
having chronic rheumatic heart disease never realized they had experienced
attacks of rheumatic fever as children. The disease causes an inflammation
of the heart muscles and heart valves, and scars the valves so that they do
not perform normally. The damage may prevent the valves from opening or
closing properly. Rheumatic fever is controlled by regular doses of
penicillin and sulfa drugs, particularly in adolescents and young adults.
Bacterial Endocarditis
This is a bacterial infection of the lining of the heart (endocardium) and
the valves which may follow rheumatic fever and also may occur in persons
with congenital defects of the heart. Bacteria, usually of the
streptococcus family, can enter the blood stream after operations on the
mouth, throat, nose, or intestines. If the microbes reach defective heart
valves, they can grow on them and cause a dangerous illness. That is why
persons with a history of rheumatic fever or those with congenital heart
abnormalities may be given penicillin or sulfa drugs before undergoing
certain operations or tooth extractions.
There are two forms of the disease, acute and subacute, with the subacute
form or more common. The acute type strikes the person suddenly and can be
fatal within a few days if immediate treatment is not given. Treatment
includes bed rest and antibiotics.
Coronary Insufficiency.
Coronary insufficiency is a term applied to heart difficulties in which the
blood flow in the coronary arteries which nourish the heart muscle itself
may be decreaced.Atherosclerosis ,a common form of hardening of the
arteries, may produce this condition by thickening or narrowing the walls
of the coronary arteries.When the arteries are narrowed, less blood and
less oxygen are carried to the heart musclemen.One form of such
insufficiency is ANGINA PECTORIS, in which the coronary arteries
temporarily do not provide the necessary blood to the heart muscle. The
amount of blood to the heart muscle may be adequate for periods of rest or
mild activity. Under conditions of emotional stress or increased physical
exertion, the supply may be insufficient for the added work of the heart,
and pain will result. The characteristic pain has been described as
crushing or viselike and located near the left breast. The pain may fan out
to the left arm and left fingers. Treatment consists of rest, nitroglycerin
tablets under the tongue, or inhalation of amylnitrite.
Heart Failure
Heart failure does not mean that the heart has stopped, but that its
pumping efficiency has lessened. Two types of failure can interfere with
normal circulation. In one, circulatory, or forward, failure, the heart is
unable to pump enough oxygenated blood to the tissues because a severe
hemorrhage may cause the blood volume to fall, or because the heart is not
capable of supplying the tissues with sufficient blood.
In the second type of failure, known as cardiac insufficiency ( backward,
or congestive, failure), the heart muscle loses its normal vigorous beat
and fails to propel the blood out of the heart chambers as swiftly as it
enters them. As a consequence of the slowing of circulation, body fluids
collect in the tissues. The ankles may swell, and the individual may be
short of breath because of fluid in the lungs. There may be various types
of indigestion from congestion of the liver and other abdominal organs.
This type of heart failure may develop after a severe heart attack or
rheumatic fever, after a long period of untreated high blood pressure, or
in connection with a congenital heart defect.
In circulatory failure, the victim is pale and listless, and visible veins
sag. In cardiac insufficiency, the victim’s skin has a bluish tinge, the
jugular vein is swollen, and he breathes noisily. The blueness stems from
the fact that not enough oxygen is being supplied to the arterial blood ,
and the tissues also lack sufficient oxygen, while carbon dioxide mounts in
the cells.
Treatment for heart failure includes rest, a special diet with lowered salt
intake, medication(digitalis) to strengthen heart action, and diuretic
medicines to control the excess of fluid.
Related Disorders
Hardening of the arteries and high blood pressure (hypertension) are two of
the most common forms of diseases affecting the heart, and are found most
frequently in the middle-aged or elderly person. The conditions may be
present separately, although they are frequently associated. In the first,
atherosclerosis, the walls of the arteries, and particularly the internal
lining called the intima, may become roughened. Fatty deposits begin to
collect. Fibrotic materials, and sometimes calcium, coat these deposits,
and help to form what are known as atherosclerotic plaques. The damage
spreads into the media, the muscular-elastic part of the artery, and causes
loss of resiliency. These plaques fill the passageway, and gradually
obstruct the flow of the blood. As the arterial walls are narrowed, it
becomes more difficult for the blood to flow through the vessel.
Rise in blood pressure may be caused by a variety of factors, including
emotional stress. In 90 percent of the cases, the specific cause remains
undiscovered. It is believed that high blood pressure helps to speed the
processes of hardening of the arteries and other blood vessel diseases.
Hardening of the arteries and high blood pressure are chiefly responsible
for STROKES (Known as celebrovascular accidents), which are caused by
clogging or hemorrhaging of an artery in the brain or in an artery in the
neck leading to the brain. The walls of an artery may have lost their
smoothness and elasticity and collected the deposits typical of hardening
of the arteries, or the artery may have been clogged by a blood clot from
the heart. An area of the brain to which the blood supply has been
interrupted is injured, as a result of which some muscular function
controlled by the brain cells may be temporarily or permanently lost.
Another disease related to diseases of the heart and blood vessels is
NEPHRITIS (Bright’s disease), or inflammation of the kidneys, which can
cause high blood pressure. The heart works under the high pressure
handicap, as in other types of hypertension. An acute attack of nephritis
may so injure the capillaries, the tiniest blood vessels, that fluid
settles in the tissues, causing swelling in various parts of the body.
Prevention and Care
Guarding against heart ailments involves a reasonable consideration for the
amount of work the heart is accustomed to doing. For example, a man over 40
should remember that a burst of unusual physical work or strenuous sport
creates a strain on a heart that is accustomed only to a sedentary life.
Extra weight places an extra burden on the heart. Fears of heart trouble
can also be harmful. It is wise to have regular medical check-ups, and take
intelligent care of one’s health, and to maintain a sensible approach to
life between examinations. This includes avoiding excessive use of tobacco,
following a well-balanced diet, taking regular exercise, and maintaining a
good balance between work, social life and rest.
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