Heart disease Cardiac problems/ angina pectoris / acute coronary syndrome / acute myocardial infarction/ heart failure

The heart is a hollow muscle about the size of a clenched fist. This muscle contracts at least 100,000 times per day and pumps the blood throughout the body. Various problems in and around the heart can result in severe symptoms.

In this article we will discuss a number of problems that can cause cardiac symptoms. Please seek advice from a GP immediately if you recognise these symptoms.

An infarction or heart attack stops the flow of blood via the coronary arteries to the heart. Part of the heart muscle will be starved of oxygen and will no longer contract. If this area goes without oxygen for too long, it will gradually start to die. Scar tissue comprised of dead cells will form at the site where the muscle cells died.

A disrupted pump functioning of the heart is referred to as heart failure. A distinction is made between systolic heart failure and diastolic heart failure. In the case of systolic heart failure, the heart muscle does not contract forcefully enough and the blood is pumped less effectively. In the case of diastolic heart failure, the heart muscle does not relax properly between contractions. As a result, the hollow muscle does not fill entirely with blood.

Other problems include: arrhythmias (the heart beats too quickly, too slowly or irregularly); conditions affecting the heart valves (the heart valves do not close properly or are narrowed, causing the heart to have to work harder); heart muscle disease (a thickening or dilation of the heart muscle, resulting in decreased pumping strength); high blood pressure (in the case of high blood pressure, the heart has to pump against high pressure. The heart produces more muscle to achieve this and becomes thicker as a result).

Depending on the type of heart problem, the symptoms can develop gradually or acutely. Sometimes the symptoms are only present during physical exertion. In other cases they are also present at rest. Various risk factors determine the chances of developing cardiovascular disease:

• Smoking.
• High cholesterol.
• High blood pressure.
• Being overweight.
• Diabetes.
• Stress.
• Unhealthy diet.
• Not enough exercise.
• Genetics: cardiovascular disease in father, mother, brother or sister before the age of 65 years.
• Increased age.
• Gender (male).

For non-acute heart complaints, the general practitioner or cardiologist asks about the symptoms. Risk factors are also discussed. As a result, a physical examination follows with blood pressure measurement and listening to the heart. Further examination may follow in the form of a heart tracing or electrocardiogram (ECG).

In the case of acute heart problems such as a heart attack, immediate action must be taken. A discussion about the symptoms follows afterwards.

The treatment depends on the type of heart complaints. It's important to address existing risk factors if possible. This can be done, for example, by leading a healthier lifestyle and:

• Quitting smoking.
• Exercising more.
• Losing weight.
• Reducing stress.
• Eating healthier.

In addition, it may be necessary to use medication or to undergo surgery on the heart and/or blood vessels.

Rutten, F.H., Grundmeijer, H.GL.M., Grijseels, E.W.M., Bentum, S.T.B. van, Hendrick, J.M.A., Bouma, M., Eizenga, W. & Pinxteren, B. van (2003) NHG-standaard. Acuut coronair syndroom Huisarts Wet. 2003; 46(14):831-43.
Hoes, A.W., Voors, A.A., Rutten, F.H., Lieshout, J. van, Janssen, P.G.H. & Walma, E.P. (2010) NHG-standaard. Hartfalen Tweede herziening. Huisarts Wet. 2010; 53(7):368-89.