Heart diseases are one the leading causes of morbidity and mortality worldwide, because of increasing sedentary lifestyle. They could be congenital or acquired.
Congenital disorder manifests in newborn, and characterized by poor feeding, blue discoloration, cough and breathing difficulty. Coronary diseases present as severe chest pain, palpitation, sweating, anxiety, fear, and syncope. Rheumatic diseases present with sore throat, pain in joints, chest pain, breathlessness and rash. Valvular heart diseases present with complaints such as dyspnea, leg swelling, cough, fever, dizziness and chest pain .
The diagnosis can be done by physical examination and investigations. In each and every case, ECG should be done. Echocardiography is important investigation which shows anatomical defects, valvular defects, and defects in pericardial space. It also asseses the pathophysiological condition of blood flow, valvular function, myocardial contraction and cardiac function like output and stoke volume.
Cardiac catheterization is important to diagnose diseases of valves and function of ventricles. Angiography detects stenoses in coronary circulation, and is also important to be done before angioplasty or stenting. It is also done to measure pulmonary artery pressure, and cardiac output. Blood pool imaging establishes left ventricular ejection fraction. Myocardial perfusion scans measure perfusion of myocardium at rest and at stress . Laboratory investigations like biochemical markers, troponin or Anti-streptolysin O (ASO) titer could be advised as required.
Blood pressure is kept under control by diet modification and antihypertensive drugs like diuretics and beta blockers. If there is suspected or diagnosed ischemia, it requires treatment with oxygen, sublingual nitroglycerine, centrally acting analgesics like morphine and platelet inhibitors like aspirin or clopidogrel.
If ECG shows abnormal rhythm, anti-arrhythmic drugs like lidocaine, amiodarone, are indicated. In worst situations, patient may need resuscitation with defibrillation.
Bradycardia is managed by atropine. Tachycardia may be managed by carotid massage or adenosine if origin is supraventricular or beta blockers, verepamil, digoxin or lidocaine if origin is ventricular or nodal .
Surgical interventions are required in certain conditions like internal pacemaker for heart block, angioplasty or stent placement for coronary diseases, valvuloplasty or valve replacement in valvular defects and septoplasty for septal defects.
Congenital and acquired valvular defects have poor prognosis, and require regular follow up to asses function, secondary infection and rejection. Prognosis of other conditions like coronary diseases and conduction disorders is good with pharmacological and surgical management. Further recurrence of underlying conditions like atherosclerosis and thromboembolism could be prevented by control of obesity, diet, diabetes, lipids and changing lifestyle .
Diseases of conduction can be due to myocardial infarction, sick sinus syndrome, hypothermia or fever, hypothyroidism and hyperthyroidism, pheochromocytoma and drugs like beta blocker and digoxin. Coronary heart diseases are due to atherosclerotic plaques in coronary vessels with superimposed changes, and increased workload to the heart like in case of exertion .
Valvular defects could be congenital or acquired secondary to conditions like rheumatic disease. The valvular condition could also be senile or due to calcification like in the case of aortic stenosis or may be due to infective endocarditis or due to trauma in the case of aortic regurgitation. Myocardial diseases are secondary to viral infection or other conditions. Pericardium can be infected by virus or mycobacterium.
In 2008, 17.3 million people died from cardiovascular diseases, accounting for total of 30% deaths. Out of this 7.3 million died because of coronary heart disease. High blood pressure, obesity, tobacco use and diabetes are associated risk factors. 9.4 million cases are attributed to high blood pressure. It is expected that there will be increasing incidence and prevalence of heart diseases .
In congenital conditions, there might be anatomical defect resulting in altered hemodynamics, either pressure overload or volume overload, altered oxygenation of blood and which might further lead to infections.
Coronary heart diseases are precipitated as a result of superimposed changes in established atheromatous plaques resulting in unfulfilled oxygen need to heart muscles resulting in ischemic changes or infarct. This can lead to death of cardiac muscle.
Diseases of conduction can be due to myocardial infarction, sick sinus syndrome, hypothyroidism and hyperthyroidism, pheochromocytoma and drugs like beta blocker and digoxin. Myocarditis is secondary to viral or rarely bacterial infection.
Pericardium can be infected by virus or mycobacterium, and may result in fluid accumulation in pericardial space .
The symptoms of heart disease range from dyspnea, chest pain and syncope to symptoms of cardiac shock like cold extremities, hypotension, confusion, and multiple organ failure. Heart diseases can be diagnosed by electrocardiography (ECG), echocardiography, X-ray, cardiac catheterization or myocardial perfusion imaging. Heart conditions are treated with medications and surgical interventions like pacemakers, percutaneous coronary intervention and coronary artery bypass graft .