CardioVascular Disease (CVD) – Heart Disease & Stroke

On this page we describe the causes, symptoms, treatment and most importantly measures you can take to avoid cardiovascular disease. CardioVascular Disease (CVD) is among the main causes of premature death in the U.K., it is a term that describes diseases of the heart and blood vessels. The main forms of CVD are Coronary Heart Disease (CHD) and stroke. For more information on strokes click here.

What is coronary heart disease and a heart attack?

Coronary heart disease comes in two main forms: heart attack and angina. The heart is one of the strongest muscles in the body. It has to be to keep blood pumping every second of your life. It is essential that your heart, veins and arteries remain in good condition.

Arteries have different names, depending on what part of the body they supply. The arteries supplying the heart are known as coronary arteries. When these arteries are affected, the result is coronary heart disease.

Coronary heart disease results from the coronary arteries becoming narrowed with fatty deposits on the inside wall. This narrowing of these arteries reduces the flow of blood to the heart and increases the chances of a blood clot blocking the artery. The formation of a blood clot is also known as thrombosis. When one of the blood vessels becomes completely blocked, the blood supply to part of the heart stops and is damaged. The results of this are a heart attack or myocardial infarction to call it by its medical name. If the blood supply to a large part of the heart is stopped it may cause death.

What causes heart disease to develop?

Heart disease as mentioned earlier is caused by the build up of fatty deposits on the walls of the arteries. The fatty deposits that build up on the artery walls takes years to build up and this process is medically known as, atherosclerosis. The fatty deposits known as ‘plaques’ are made up of many substances including a fatty substance called cholesterol (for more information on cholesterol click here). If you have high levels of cholesterol in your blood the fatty deposits will increase, so you should try to cut down on saturated fats. Butter, margarine, meat, milk and cakes are all major sources of saturated fats. See below for further risk factors which can increase the chances of you developing heart disease.

What are the risk factors for heart disease?

There are a number of things you can do to help reduce your risk of heart disease, though some factors like age cannot be changed. These risk factors include:

• High cholesterol – the average diet in the U.K. is very unhealthy, the consumption of fatty foods is far too high and the intake of fruit and vegetables is far too low.
• Smoking – this is one of the main factors, which causes heart disease, causing 1 in 5 of all heart disease deaths. Smoking harms your heart because the chemicals in the cigarette smoke damage arterial linings, leading to heart disease. It may also encourage  thrombosis.
• High blood pressure.
• Previous heart disease.
• Diabetes .
• Physical inactivity (lack of exercise) – an average person should aim for at least 30 minutes of moderate exercise on most days of the week. Physical activity should be introduced gradually and at appropriate levels for the age and health of the individual. Regular exercise makes your heart grow stronger, so that it can pump more blood with each beat.
• Alcohol – heavy drinkers are twice as likely to die of heart disease than non-drinkers.
• Overweight (more than 20%) – being overweight is associated with raised blood pressure, high cholesterol and inactivity, therefore you have an increased risk of heart disease.
• Age – over 45 in men and 55 in women.
• A family history of early heart disease.
• A raised homocysteine level – raised homocysteine levels are thought to damage the lining of the arteries and may also be a factor in increasing blood clots. High homocysteine levels may be caused by kidney disease, insufficient folic acid in your diet, age, lupus and certain medications.

What are the symptoms of heart disease?

As the coronary arteries narrow, patients will often experience chest pain or tightness, known as angina. This pain may spread to the left shoulder or arm or to the neck and jaw. The pain can occur after exercise, a strain, in stressful situations and especially in the cold weather. Palpitations, when you are aware that you heart is not beating normally or shortness of breath, when doing light activity, may also be early symptoms of heart disease. However, some people can have heart disease without having any noticeable symptoms. If you have any concerns about heart disease you should consult your doctor for advice.

What is angina?

Angina is a Latin word meaning chest pain and is the main symptom of heart disease. People with angina experience frequent chest pain, which is usually worse after or during exercise as the heart struggles to get the oxygen it needs. The pain lasts a few minutes and usually goes away after rest. Angina is the hearts way of saying that it is not getting enough oxygen. This can be either because the coronary arteries that supply blood to the heart are blocked or because the heart is being over worked and needs more oxygen than normal. The pain can be mistaken for indigestion because the tight, burning sensations are similar.

What are the symptoms of a heart attack?

A heart attack is more likely to occur between 5am and 10am and the body is likely to send one or more warning signs of a heart attack, these include:

• An uncomfortable pressure or pain in the centre of the chest lasting for more than a few minutes.
• Pain spreading to the shoulders, neck or arms. The pain may be mild or intense.
• Chest discomfort with dizziness, fainting, sweating, nausea or shortness of breath.
• Anxiety, nervousness and/or cold sweaty skin.
• An increased or irregular heart rate.

If you believe you are having a heart attack or have any of the symptoms mentioned you should call 999 immediately.

What can I do to reduce the risks of heart disease?

Heart disease and attacks are common but they’re not inevitable, there is action you can take to reduce your risk of developing heart disease. There are many risk factors of heart disease that are mentioned above and those that can be avoided should be avoided, try giving up smoking, take up some form of regular exercise, even walking can be beneficial and eat a healthy balanced diet.

An aspirin a day can be beneficial in preventing a heart attack. However, before taking aspirin you should speak to your doctor to make sure you are okay to take it daily.

How is heart disease diagnosed?

Heart disease is only usually diagnosed when a person develops symptoms of the disease and unfortunately a heart attack can be the first sign. If you have symptoms that suggest you mat be suffering from heart disease your doctor will probably carry out a physical examination and may arrange for you to have a number of tests. Tests that you may have include a chest x-ray, electrocardiogram (ECG) or a coronary angiography.

An ECG monitors the heart’s electrical activity and records any problems with the heart’s rhythm. An ECG can also tell the doctor if you have had a previous heart attack or if your heart is enlarged. You may also have an ECG carried out before, during and after exercise (usually on a treadmill) as some heart problems only show up when the heart is working hard, this is known as a stress test.

A coronary angiography is a fine tube that explores the coronary arteries, it detects if any of the arteries are blocked or seriously narrowed.

What treatment is available for heart disease?

A diagnosis of heart disease can be quite worrying, however, there are many treatments and steps you can take to reduce the risk of you suffering a heart attack. If the heart is not too badly damaged a change in lifestyle and medication is usually the recommended treatment. Medication that you may be given include, Beta-blockers, which reduce the hearts demand for oxygen, nitrates, to lower your blood pressure or diuretics to increase the flow of urine and help lower blood pressure.

If damage is severe and/or medications fail to help, surgery may be necessary. There are two main types of surgery available angioplasty and a coronary bypass.

A bypass is highly effective in people with heart disease and angina that’s not widespread. It can improve your ability to exercise, reduce symptoms and decrease the amount of drugs you need to take. An angioplasty operation involves a balloon being positioned into the coronary artery and inflated and deflated to improve the passage for the flow of blood. It is removed after the operation and the patient will usually remain awake throughout. If this operation does not work a bypass may then be needed.

In a bypass operation, a blood vessel, usually taken from the leg or chest, is grafted onto the blocked artery, bypassing the blocked area.

It is important to remember that though the medication and surgery may alleviate your symptoms, they cannot cure it.

On rare occasions you may be offered a heart transplant, this is where the heart is removed and replaced with a healthy heart from a donor. A lung transplant may be carried out at the same time. Unfortunately there is a shortage of donors which is why heart transplants are only carried out when heart disease is at an advanced stage.

Is it important to get treatment straight away after a heart attack?

Most people who suffer a heart attack wait 2 hours before seeking medical help, they put their chest pain down to indigestion or expect the pain to go away. Those people who survive a heart attack are usually left with permanent damage to their heart, this damage occurs during the first hour of a heart attack.

A heart attack is not a one-time event that just happens, it usually evolves over 4-6 hours and with each passing minute, more tissue is deprived of oxygen and deteriorates or dies. This is why if you believe you may be suffering a heart attack or notice any of the symptoms mentioned above, you should call 999 immediately.

If you think you are having a heart attack it is also advised that you take an aspirin (unless you are allergic). An aspirin makes your blood less likely to clot. If possible chew the aspirin as this will get it into your system faster.

What happens after a heart attack?

If the blood supply to the heart is cut off severely or for a long time, the muscle cells suffer irreversible injury and die. Disability or death can be a result of this, depending on how much muscle is damaged. If a heart attack affects the bottom of the heart and affects less than 10% this would be considered a mild attack. If more than 40% of the heart is damaged death can occur. A heart attack is a signal for you to make some changes in your lifestyle. Begin to eat a healthy diet, exercise and if you smoke quit. Talk to your doctor about how you can live a normal life as soon as possible.

Some people may need to have surgery after a heart attack, a bypass or angioplasty, whereas others may just need to take medication, it all depends on how damaged the heart and arteries are.

Facts about heart disease:

• In the U.K. some 200,000 people every year will have a heart attack and around 160,000 will die, making cardiovascular disease one of the U.K.’s biggest health problem, second only to Cancer.
• Someone in the U.K. has a heart attack every 3 minutes.
• 1 in 4 men and 1 in 6 women now die from heart disease.