What is it?

Angina is the chest pain or discomfort that occurs when your heart muscle is not getting a sufficient supply of oxygen-rich blood. In most cases, this lack of blood supply is a sign of coronary artery disease (CAD), which is caused when a sticky substance called plaque builds up on the walls of your arteries, causing them to narrow and reduce the blood flow to your heart.

What does angina feel like?

Pressure, tightness, heaviness or a squeezing pain in your chest, especially behind your chest bone, are signs of an angina attack. The pain may also radiate to your shoulders, arms, neck, jaw or back.

Sometimes angina patients may also suffer from indigestion, heartburn, weakness, sweating, nausea, cramping and shortness of breath. Since these are also signs of other serious cardiovascular conditions, you should visit your doctor for an accurate diagnosis when you experience chest pain.

Is there more than one type of angina?

Yes. There are three types: stable angina, unstable angina and variant angina.

Stable angina is the most common and is treatable with medication. For patients who suffer from it, attacks are regular and predictable; they commonly last five minutes or less, and usually occur during exertion, emotional stress and/or after a heavy meal.

Unstable angina is less common and more dangerous since attacks do not follow a regular pattern, are less predictable, can happen without physical exertion, and are not relieved with rest or medication. While it is not a heart attack, unstable angina can be a precursor to a heart attack.

An angiogram is simply a series of x-ray images of your blood vessels or of your heart (a coronary angiogram) which are taken after a special dye or contrast agent is injected.

Why should I have an angiogram?

An angiogram can be invaluable to your doctor because it can help to accurately identify the exact location and severity of any coronary artery blockage you may have. They are especially helpful for heart attack and severe angina patients as well as for those whose tests for coronary artery disease have revealed significantly abnormal results, which call for further investigation. Having an angiogram performed will also assist your doctor in determining the optimal treatment for your heart condition.

How is a coronary angiogram performed?

Having an angiogram performed is not a very uncomfortable procedure. You will be given local anesthesia to numb the area and may also receive intravenous sedation to relax you.

• A doctor will insert a small catheter through your skin into an artery in either your groin or your arm.
• With the help of a special x-ray viewing instrument called a fluoroscope, the catheter will be guided into the major arteries which supply blood to your heart (coronary arteries).
• A small amount of contrast dye is injected into each coronary artery so that x-ray images can be taken.
• After the procedure, which usually takes 30-40 minutes, the catheter is removed and the artery where the catheter was inserted is stitched, ‘sealed’ or manually compressed to prevent bleeding.
• Often, if an angioplasty or stent is indicated, it will be performed as part of the same procedure.

Coronary angioplasty (also referred to as percutaneous coronary intervention or PCI) is a medical procedure in which a balloon is inserted into a coronary artery which has become blocked by plaque build ups/clots to excessive plaque build-up and requires opening to improve the flow of blood pressure, anti- platelet and cholesterol lowering medication to your heart.

This now common medical procedure is minimally invasive and is performed in a cath lab on heart patients for purposes such as:

• Improving coronary artery disease (CAD) symptoms, such as angina and shortness of breath
• Reducing the chance of heart muscle damage during a heart attack
• Reducing the risk of death in some heart patients.

How is an angioplasty done?

Before a doctor recommends angioplasty, he will usually recommend that you have an angiogram done to determine whether you have any artery blockages, how many you have and where they are located.

Once this information is determined, the angioplasty can proceed. In a procedure similar to an angiogram, a balloon will be inserted and inflated at the point of blockage to open up the artery and improve blood flow.

Once the balloon is inflated, a small mesh tube called a stent will be placed in the widened artery to keep it open and reduce the risk of the artery re-narrowing.

Some stents are coated with slow-release medications which help prevent the artery from becoming blocked by scar tissue that may grow around the stent.

Will I be able to function normally after angioplasty?

Most angioplasty patients can return home one to two days after angioplasty and can expect to recover fully within a week or less.

After having angioplasty, making healthier lifestyle and diet choices are strongly recommended both to improve coronary artery disease and to prevent your newly re-opened arteries from narrowing and becoming blocked again. Lifestyle changes include a healthy diet, weight control, regular physical activity, quitting smoking and of course, taking any blood pressure ,anti- platelet and cholesterol lowering medication your doctor may have prescribed.

An arrhythmia is a change in the normal rate or rhythm of your heartbeat, which is why it is sometimes called an irregular heartbeat or ‘dysrhythmia’. It means your heart is beating too quickly, too slowly or irregularly (e.g. when your feel as if your heart is ‘skipping a beat’ or ‘fluttering’).

A faster-than-normal heartbeat is called tachycardia. One that’s slower than normal is called bradycardia.

What causes arrhythmias?

Your heart has an internal electrical system that controls the rhythm of your heartbeat. Any problem with that system can cause your heart to beat abnormally.

Minor arrhythmias may be brought on by excessive alcohol use, smoking, caffeine, stress or exercise. Blood chemistry imbalances, abnormal hormone levels and even some medications may also be the cause. Heart disease is, however, the most common cause, especially coronary artery disease, abnormal heart valve function, heart attack and heart failure. In certain cases, an arrhythmia can occur for no known reason.

What are does an arrhythmia feel like?

Not all people who have an arrhythmia feel the same way. Symptoms may include:

• Heart palpitations, or rapid beating or thumping in your chest
• Skipping or fluttering heartbeats
• A slower than normal heartbeat
• Tiredness, dizziness, feeling faint or light-headed
• Shortness of breath
• Paleness
• Chest pain

Should I be worried about it?

In most people, arrhythmias are minor and are not dangerous. However, it would still be wise to visit your doctor for a thorough check because in some cases – especially if you have other heart conditions – an arrhythmia can be dangerous and require treatment.

How can I find out if I have an arrhythmia?

To determine if you have an arrhythmia, your doctor can run tests like an electrocardiogram (ECG or EKG), a stress test or a Holter monitor. Once he determines whether or not you have an arrhythmia and if you do, how serious it is, he may recommend treatment to restore a normal heart rhythm. Treatment may range from medication to an implantable cardioverter defibrillator (ICD) or a pacemaker.

Many people think that cardiac arrest (or sudden cardiac death) is a heart attack but this is not so.

Sudden cardiac arrest occurs when your heart abruptly stops beating causing you to lose consciousness, stop breathing normally and show no sign of a pulse or blood pressure.

During a heart attack, your heart muscle may be damaged due to a lack of blood flow and oxygen, but your heart continues to beat albeit abnormally. A severe heart attack can, however, lead to sudden cardiac arrest.

What causes sudden cardiac arrest?

The most common cause of cardiac arrest is ventricular fibrillation. Simply put, your heart’s internal electrical system malfunctions, causing an arrhythmia, which stops your heart from beating and pumping blood to your brain and body.

There are many possible causes of cardiac arrest, the most common of which are coronary heart disease and heart attack. Less common causes are electrocution, drowning, choking, the inability to breathe, and trauma. In very rare cases, there may be no known cause.

What are my chances of surviving cardiac arrest?

The only way to reverse cardiac arrest is by having CPR (cardiopulmonary resuscitation) or defibrillation (electrical shocks to restore your heartbeat) administered within five to seven minutes. Without immediate medical attention, a person in cardiac arrest will die within a few minutes. The earlier you receive these life-saving measures, the greater your chances of survival.

Cardiomyopathy refers to diseases which affect the muscle of your heart causing it to become inflamed, enlarged or thicker and more rigid than normal. In rare cases, the muscle tissue is replaced by scar tissue.

Some people with cardiomyopathy can live long, healthy lives. However, in others, the diseased muscle can weaken your heart and restrict its ability to pump blood to your body which can lead to complications such as: heart failure, arrhythmias, fluid retention in your legs or lungs, and inflammation of your heart’s lining (called endocarditis).

Is there more than one type of cardiomyopathy?

Yes. There are four main types of cardiomyopathy:

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Arrhythmogenic right ventricular dysplasia (ARVD)

What causes cardiomyopathy?

Some causes of cardiomyopathy are specific e.g. a heart attack, Is High Blood Pressure treatable or a viral infection. Some types of cardiomyopathy are genetic, and therefore the condition can run in families. For many, however, the cause is unknown.

What are the symptoms of cardiomyopathy?

Many people with cardiomyopathy may not realise that there is a problem with their heart muscle, especially when the disease is in its early stages. However, when your heart becomes weaker as the disease progresses, you may experience symptoms such as:

• Tiredness,
• Weakness
• Shortness of breath after exercise or when at rest
• Feeling dizzy or lightheaded
• Fainting when exercising
• Swelling in your abdomen, legs, ankles and feet
• An abnormal or irregular heartbeat may also be signs.

Can cardiomyopathy be treated?

Some people may not need treatment, especially if they have no symptoms. How you are treated usually depends on the type of cardiomyopathy you have. Your doctor may prescribe medications or may recommend surgery or non-surgical procedures. Treatment may usually include adopting healthier lifestyle habits.

Cholesterol is a waxy, fat-like substance made by the liver that is present in the cell walls in all parts of the body and which, in the right amounts, is needed for your body to function normally. Cholesterol also is present in foods we eat.

Why are high levels of cholesterol dangerous?

High levels of blood cholesterol can increase your risk of heart disease. If you have too much cholesterol in your blood, it can stick to the walls of your arteries forming a sticky substance called plaque. Uncontrolled build-up of plaque eventually narrows your arteries or even blocks them, restricting and sometimes stopping the flow of blood and oxygen to your heart.

How will I know if I have high cholesterol?

Since most people with high blood cholesterol usually have no signs or symptoms, it is important to have your blood cholesterol levels tested, especially as you get older since cholesterol levels tend to rise as you get older.

People with a family history of high cholesterol, who are overweight or who eat too many fatty foods are more at risk for having high cholesterol.

How can I lower and control my cholesterol levels?

You can lower your cholesterol by making healthier lifestyle and diet choices such as:

• Eating foods with less fat, saturated fat and cholesterol
• Removing the skin and trimming the fat from meat, poultry and fish
• Frying less, and broiling, baking, roasting or poaching more
• Including more fruits, vegetables and whole grain foods in your daily diet
• Exercising daily, on your doctor’s advice
• Losing weight if overweight
• Stopping smoking
• Taking doctor-prescribed medications for reducing cholesterol.

A congenital heart defect is a structural problem with the heart which is present at birth. Congenital heart defects are the most common type of major birth defect.

What causes a congenital heart defect?

Soon after a baby is conceived, its heart begins to develop. While developing, defects in the heart’s structure can occur, causing malformation of the heart’s walls, valves, arteries or veins. These defects can disrupt the normal flow of blood through the heart and cause it to slow down; go in the wrong direction or to the wrong place; or block the blood flow entirely.

Can a congenital heart defect be treated?

Most congenital heart defects are simple conditions that can easily be fixed or require no treatment. Some children, however, are born with complex congenital heart defects that require special medical attention soon after birth. Most people with complex heart defects will need special heart care throughout their lives.

Treatment will vary depending on the type and severity of the defect as well as the age, size and health of the child. Treatment may include medication, surgery and/or other medical procedures. In the cases of a severe heart defect, a heart transplant may be required.

Thanks to advances in diagnosis and treatment, most children born with a heart defect can grow up to lead active, productive lives.

Some people mistakenly believe that congestive heart failure means that your heart stops working or is about to stop working. Heart failure (also referred to as CHF, cardiac failure, left or right-sided heart failure) is a condition in which the heart is unable to pump sufficient oxygen-rich blood throughout the body to meet its needs. In other words, your heart is not pumping blood the way that it should.

What causes congestive heart failure?

The most common causes that may lead to heart failure are:

• Coronary artery disease (CAD)
• High blood pressure (hypertension)
• Diabetes
• Sustained alcohol abuse
• Heart valve disorders.

There are many other causes including:

• Viral infections of stiffening heart muscle
• Thyroid disorders
• Heart rhythm disorders
• Certain medications.

What are the symptoms of congestive heart failure?

When your heart progressively gets weaker and cannot adequately pump blood, you may experience:

• Tiredness and general fatigue
• Fluid retention (swelling) in your feet, ankles, legs and abdomen
• Shortness of breath from fluid build-up in your lungs
• Difficulty sleeping in a lying position (due to shortness of breath)
• Increased urination (especially at night)
• Nausea, loss of appetite and abdominal pain from fluid retention in your liver or intestines.

How is congestive heart failure treated?

Heart failure is a serious condition which, in the U.S., is the cause of 300,000 deaths annually. Once diagnosed by your doctor, you should immediately be treated.

Making changes in your diet and lifestyle, e.g. controlling your salt and fluid intake, is an important first step. Your doctor may also treat the underlying cause of your heart failure or give you certain medications. If with treatment, the condition continues to worsen, heart transplantation may be the life-saving option.

Although pain or pressure in the chest is the most common symptom of a heart attack, other signs that you may be having a heart attack include:

• Chest discomfort – pain, fullness, and/or squeezing sensation
• Shortness of breath
• Discomfort in the upper body – in your arm and shoulder (commonly on the left side but can be felt on either side), pain in your neck and upper back
• Jaw pain, toothache, headache
• Nausea, vomiting, and/or general discomfort in your upper mid-abdomen
• Heartburn and/or indigestion
• Dizziness, lightheadedness and/or sweating
• General malaise (vague feeling of illness).

In about a quarter of all heart attacks, patients experience no pain or symptoms. These are called ‘silent heart attacks’ and are particularly common in diabetes patients. Women often experience different symptoms to men.

How can I tell if I am at risk for having a heart attack?

Several factors may contribute to a higher risk of having a heart attack. These include:

• High blood cholesterol levels
• High blood pressure
• Smoking
• Diabetes mellitus
• A family history of heart disease
• Gender – the incidence of heart attacks in men is higher than in women, especially when they are younger. However, this does not mean that women are not at risk. In fact, the risk of coronary artery disease increases significantly as women age and enter menopause.

Heart valve disease-Valvular Regurgitation(also called valvular) describes any condition that occurs when the valves of your heart are not working the way they should.

Your heart has four valves which control the flow of blood into, through and out of your heart by opening to let blood in then, closing to keep the blood from flowing backward. If your heart valves don’t work properly, it can lead to problems such as:

• Valvular regurgitation (also called valvular insufficiency or incompetence) – This happens when one or more of your heart valves do not close tightly enough causing blood to leak back through the valve in the wrong direction. Mitral valve prolapse, one of the most common heart valve conditions, is an example of this.
• Valvular stenosis – This happens when one or more of your heart valves has a smaller than normal opening, which restricts or blocks the flow of blood into and through your heart.

What causes heart valve disease?

Valve disease can be ‘congenital’ (a defect that is present from birth) or may be ‘acquired’ (a once normal valve develops a problem due to disease or infection such as rheumatic fever and endocarditis).

Other causes of valve disease include: coronary artery disease, heart attack, heart muscle disease (cardiomyopathy), syphilis, high blood pressure, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some drugs and radiation.

What are the symptoms of heart valve disease?

Symptoms may include:

• Shortness of breath and/or difficulty catching your breath
• Weakness or dizziness
• Chest discomfort – feelings of pressure or weight in your chest
• Heart palpitations – rapid, irregular, skipping for ‘flip-flopping’ heart beats
• Swelling in your legs, ankles, feet or abdomen
• Rapid weight gain.

Sometimes people experience no symptoms but may still have a serious valve disease.

How is heart valve disease treated?

Some valve problems are minor and require no treatment. More severe forms of valve disease may require treatment with medication, undergoing medical procedures or having surgery to repair or replace the defective valve.

High blood pressure (also called HBP, HTN or ‘hypertension’) occurs when your blood circulates through your arteries with too much force. When your doctor measures your blood pressure, he is looking for two readings:

• The force (pressure) which is exerted on your artery walls whenever your heart beats to pump blood into your arteries. This is known as your systolic pressure.
• The pressure in your arteries between heartbeats when your heart is at rest, called your diastolic pressure.

Your doctor records the readings as numbers, putting the systolic pressure measurement on top of (or before) the diastolic pressure measurement.

When is blood pressure considered high?

A blood pressure reading of:

• 120/80 or lower is considered normal.
• 140/90 or higher indicates that your blood pressure is high.
• Between 120/80 and 139/89, tells your doctor that you may be ‘prehypertensive’.

Why is it important to have my blood pressure checked?

Since most people with high blood pressure usually experience no symptoms, it is advisable to have your blood pressure checked regularly. Not treating high blood pressure can lead to serious heart and health problems like stroke, heart failure, heart attack and kidney failure.

Who gets high blood pressure?

Children as well as adults can suffer from high blood pressure; however it is more common in adults over the age of 35. Among those who are more susceptible are:

• People of African descent
• Middle-aged and elderly people
• Obese people
• Heavy drinkers of alcohol
• Women on birth control pills
• People with a family history of high blood pressure
• People who live or work under high-stress conditions
• Diabetes, gout or kidney disease patients.

Is high blood pressure treatable?

Yes. High blood pressure can be controlled though healthy lifestyle and eating habits as well as with medication.

A cardiac pacemaker is a small device that is placed under the skin of your chest or abdomen to help control abnormal heart rhythms (arrhythmias) which occur as a result of a problem with your heart’s electrical system.

How does a pacemaker work?

Once implanted, a pacemaker sends electrical impulses to your heart to prompt your heart to beat at a more normal pace and help to reduce symptoms like fatigue and fainting so that you can lead a more normal, active life.

Are all pacemakers permanent?

No. For some patients, the problem with their heartbeat may be only temporary e.g. a slow heartbeat due to a heart attack, heart surgery or an overdose of medicine. In cases like these, a temporary pacemaker will be implanted until the condition returns to normal. Temporary pacemakers are also used during an emergency until a permanent pacemaker can be implanted. For many patients however, pacemakers are permanently implanted.

What is an implantable defibrillator?

An implantable cardioverter defibrillator (ICD) is essentially a miniature version of the defibrillators used in a hospital on patients whose heart suddenly stops beating during cardiac arrest to ‘shock’ their heart into beating again.

An ICD is small electronic device, which is implanted into your chest, to monitor your heart rhythm. When your heart beats normally, the ICD remains inactive. However, if your ICD senses a dangerous, life-threatening heart rhythm, it will instantly deliver an electrical ‘shock(s)’ to your heart to stop the abnormal rhythm and bring your heartbeat back to normal.

Since many ICDs are now able to record your heart’s electrical patterns during heartbeat abnormalities, they can help your doctor in planning future treatment options.

Heart surgery is any surgical procedure that is done to correct a heart problem(s) in children and adults. In the U.S., more than half a million heart surgeries are performed annually. Here at Caribbean Heart Care, we now perform 300 to 400 heart surgeries each year with a success rate of over 97 percent.

What is heart bypass surgery?

Heart bypass surgery or coronary artery bypass grafting (CABG) is the most common surgery procedure performed on adults. This surgery is done to redirect the flow of blood from major arteries leading to the heart that are blocked. During bypass surgery, surgeons take healthy arteries or veins from another part of the body to ‘bypass’ blocked arteries as a means of improving heart blood flow as well as reducing chest pain and the risk of heart attack.

What else may require heart surgery?

Heart surgery may also be done to:

• Repair or replace defective heart valves
• Repair abnormalities or damage to the heart’s structure
• Regulate heart rhythms or blood flow with implantable devices
• Replace a damaged heart with a healthy donor heart (i.e. heart transplant).

What is ‘open heart’ surgery?

Once a patient’s chest is opened for surgery to be performed on the heart, it is referred to as ‘open heart’. This is done by cutting through the breastbone to expose the heart.

In traditional ‘on-pump’ heart surgery, once the heart is exposed, the patient is connected to a heart-lung bypass machine which mechanically pumps blood through the patient’s body giving surgeons the opportunity to operate on an unbeating heart.

A more recent medical advance has led to the introduction of ‘off-pump’ surgery (also called ‘beating heart’ surgery), which does not require placing the patient on a heart-lung bypass machine for surgery to be performed on the heart.

Are all heart surgeries ‘open heart’?

No. There are some surgical procedures that are ‘minimally invasive’. This means the surgical incisions are much smaller than in traditional open heart surgery, and may reduce the risk to the patient as well as the amount of time required for recovery.

If you have been told that your require heart surgery, your cardiologist and surgeon will evaluate all surgical options before deciding on which type of heart surgery is the best in your case.

What are the chances of my surviving heart surgery?

With the many advances that have taken place in field of heart surgery, the vast majority of heart patients have an excellent chance at survival. In fact, if you have a severe heart problem, having heart surgery will in all likelihood reduce your symptoms and help you live a longer and better quality of life.