Cardiomyopathy

Heart Disease

Hypertrophic cardiomyopathy

The heart muscle thickens greatly (often asymmetrically) and the muscle cells may become disorganised (which can interfere with the passage of electrical signals through the muscle), without any obvious trigger. In most cases the disease is hereditary, resulting from a gene abnormality. The disease is thought to affect at least 125,000 people in the UK.

In one form of hypertrophic cardiomyopathy (hypertrophic obstructive cardiomyopathy or HOCM) the muscle mass of the left ventricle and the wall that divides it from the right side of the heart (the septum) becomes larger than it should be. This leads to narrowing of the passage through the heart and obstruction of the blood flow out of the heart.

In addition the muscle is stiff and has difficulty relaxing, increasing the amount of pressure required to expand the heart while blood flows in. This reduces the blood holding capacity of the heart.

The altered structure may distort the mitral valve between the chambers of the heart (the left atrium and left ventricle) which may then leak. It’s also known as asymmetric septal hypertrophy (ASH) or idiopathic hypertrophic subaortic stenosis (IHSS).

The condition can be present in the foetus and cause stillbirth, or may develop in infancy. But, more usually, it develops during childhood or early adulthood.

In another form of the disease, non-obstructive hypertrophic cardiomyopathy, the enlarged muscle doesn’t obstruct the blood flow.

The symptoms of hypertrophic cardiomyopathy include shortness of breath on exertion, dizziness, fainting and angina pectoris (angina is chest pain or discomfort caused by reduced blood supply to the heart muscle.) The obstruction to blood flow from the left ventricle increases the ventricle’s work, and a heart murmur may be heard. Some people have cardiac arrhythmias. These are abnormal heart rhythms that in some cases can lead to sudden collapse and death.

Treatment, which includes anti-arrhythmia drugs, aims to control symptoms and prevent complications such as sudden collapse. Surgery may be necessary to remove some of the muscle or repair the mitral valve. A special device called an implanted cardioverter defibrillator (ICD) may need to be put into the heart to deliver and electric shock which will get the heart back into a normal heart rhythm whenever arrhythmias occur, in order to prevent sudden death.

Because there may be a genetic cause, other members of the family should be screened to check for the faulty gene.

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Aortic stenosis

Heart Disease

What is aortic stenosis?

Normally, blood passes from the left lower chamber of the heart, called the left ventricle, through the aortic valve into the main artery of the body, the aorta.

If the aortic valve becomes narrowed, or stenosed, the blood flow through it is reduced and the heart has to work harder to pump blood to the body.

Aortic stenosis is more common in men. It can be present at birth but is more likely to occur in older people.

Heart Failure: Should I Get a Pacemaker (Cardiac Resynchronization Therapy)?

Heart Disease

Decision Point

You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Failure: Should I Get a Pacemaker (Cardiac Resynchronization Therapy)?

Compare your options

Compare

Get a pacemaker Don’t get a pacemaker
What is usually involved?
  • The doctor will numb the area so you won’t feel pain. (This is not open-chest surgery.)
  • It can take up to 2 to 3 hours to place the pacemaker.
  • You may spend the night in the hospital to make sure that the device is working and that there are no problems.
  • You will need regular checkups to make sure that the pacemaker is working and to adjust the pacing, if needed.
  • You still need to take medicines for heart failure.
  • You still have to eat healthy foods and exercise as your doctor advises. You also may need to limit salt and fluids.
  • You take medicines for heart failure. Your doctor may change the type or dose of your medicines.
  • You have to eat healthy foods and exercise as your doctor advises. You also may need to limit salt and fluids.
  • You may have to see your doctor often to check your symptoms and how your medicine is working.
What are the benefits?
  • A pacemaker can help you feel better so you can be more active.
  • It can help keep you out of the hospital and help you live longer.
  • It can help your heart pump better by changing the shape of your heart. In heart failure, the left ventricle often gets too big as it tries to make up for not pumping well.
  • You won’t have the risk of infection or other problems from the surgery.
What are the risks and side effects? The risks from surgery are usually low. But they may be different for each person. Here are some possible risks:4

  • A lead could tear the heart.
  • A lung could collapse from a buildup of air in the space between the lung and the chest wall.
  • You could get an infection in the chest.
  • The doctor might not be able to place the pacemaker. For example, a vein could be too small to place a lead.

After surgery, you may have some other risks:

  • You will need surgery to replace the battery, which lasts 8 to 10 years.
  • If a lead breaks or the pacemaker stops working, you may need another surgery to fix the problem.
  • Some devices with strong magnetic or electrical fields could stop the pacemaker from working. You need to avoid MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances and electronic devices are safe.
  • Your symptoms could get worse. This would limit your ability to do your daily activities.
  • If your heart failure gets worse, you may have to go into the hospital a lot.
  • You might not live as long as you could if you had a pacemaker.2

Heart Attack

Heart Disease

If you are having pain or discomfort in your chest, jaw, shoulder, arm, or back and think you may be having a heart attack, call 911 immediately. Do not delay or try to “wait it out.”

If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Go immediately to a hospital emergency department. Do not attempt to drive yourself or have someone else drive you. Call 911 for emergency transport.

The heart is a muscular pump located in the chest. Its job is to pump blood around the body via the circulatory system of blood vessels. The heart consists of 4 chambers: right atrium and right ventricle, and left atrium and left ventricle.

  • Blood is depleted of oxygen after circulating through the body. This blood returns into the right atrium. From there the blood flows into the right ventricle, which pumps the blood out to the lungs for oxygenation.
  • The oxygen-rich blood then returns to the left atrium. From there it flows into the left ventricle and is pumped out at high pressure into the arteries.

The high pressure is generated by powerful contraction of the heart muscle.

  • This raises the pressure of the blood and enables it to flow through the extensive network of arteries to every part of the body and return to the heart.
  • For this pumping action, the heart has to be strong.

The heart is nourished by the blood supplied directly to the heart muscle through the coronary arteries.

  • The strength of the heart muscle depends very much on this blood supply.
  • The coronary arteries are usually strong, elastic, and quite flexible. The inner lining of the arteries is normally smooth. This allows the blood to flow smoothly without clotting.

Heart attack is caused by sudden loss of blood and oxygen to your heart.

  • The most common condition that predisposes a person to heart attack is coronary heart disease, or coronary artery disease.
  • The plaque and resulting blood clots block the artery partially or completely, reducing the amount of blood that can flow through the artery to the heart.
  • This cuts off the oxygen supply to part of the heart muscle.
  • If the blood supply is cut off long enough, that part of the heart muscle dies. This is a heart attack.
  • If a large enough part of the heart muscle is affected, a dangerous rhythm disorder called ventricular fibrillation may occur.
  • If this happens, the heart may stop. This is called cardiac arrest, and most people who have cardiac arrest die.

Despite immense medical progress in the last 3 decades, heart disease continues to be a major health problem in both industrialized and developing nations.

  • About 1.5 million Americans suffer a heart attack each year (that?s 1 heart attack every 20 seconds).
  • Many people die before getting medical attention. Approximately 90-95% of people who reach a hospital alive after a heart attack will survive.
  • Overall, about one third of people who have a heart attack die.
  • Heart disease is the leading cause of death in the United States.

Clearly, time is of the essence. Recognizing the symptoms of a heart attack and seeking immediate medical attention may mean the difference between life and death.

  • Immediate death may be avoided if cardiopulmonary resuscitation (CPR) is begun within 4 minutes of the cardiac arrest.
  • CPR involves breathing for the person (mouth-to-mouth resuscitation) and performing chest compressions to keep the blood circulating. This provides at least a small amount of oxygen to the heart and brain.

Survival depends on quick action.

  • Emergency personnel will assess the situation quickly. They may record an electrocardiogram (ECG).
  • If the person has ventricular fibrillation or there is no pulse, they may administer electrical current to the chest (defibrillation) to “shock” the heart back to normal rhythm.
  • Other emergency treatments include medications and CPR.

Bystanders can help a cardiac arrest victim before emergency personnel arrive.

  • Ventricular fibrillation often can be treated successfully with a defibrillator.
  • Automated external defibrillators (AEDs) are now becoming available in many public places such as airports and airplanes, shopping malls, sports arenas, and office buildings.
  • These devices are designed so that they can be used in cardiac arrest by untrained bystanders.
  • Even if an AED is not available, you can take part in the “chain of survival” by performing CPR until help arrives.