Cardiovascular health can be complicated because there is often interplay between the various conditions, meaning many people have more than one at the same time. For example, someone with raised blood pressure may also be on medication for an arrhythmia and for preventing coronary heart disease.

The major problems that can affect the heart itself are collectively known as cardiac disorders.

Angina

Angina is one of the conditions covered by the term coronary heart disease, in which the blood vessels supplying the heart itself become narrowed. Angina typically presents with pain in the chest, neck, shoulders, jaw or arms. It may be stable, which means it occurs predictably as a result of physical exertion or stress, and is quickly relived by rest or medication, or unstable, which is much more dangerous and can lead to other problems such as a stroke, myocardial infarction or death.

Myocardial infarction

Also known as a heart attack, a myocardial infarction (MI) involves the blood supply to the heart being interrupted. This is usually because of a blood clot forming in the coronary artery in response to the rupture of an atheroma – a collection of debris including fats. Not everyone experiences symptoms, but those who do may complain of severe chest pain, which may radiate to the left arm, neck or jaw; nausea; vomiting; sweating; pale skin; breathlessness; and collapse.

A heart attack caused by a partial clot in the coronary artery is called a non-ST elevated MI (NSTEMI), which refers to the shape of the wave on an electrocardiogram (ECG). A full blockage of the coronary artery is much more serious and is termed an ST elevated MI (STEMI).

Swift medical attention is essential, to limit the damage done to the heart and hence improve the patient’s prognosis. Complications as a result of an MI can include heart failure, angina, a stroke – blockage of the artery to the brain due to a blood clot – arrhythmias and death. There can also be a significant impact on mental health, with many MI survivors going on to experience depression and anxiety.

Heart failure

In heart failure, the heart is unable to maintain the circulation of the blood and meet the demands of the body. It can be acute or chronic, but the latter is much more common, affecting more than one in seven people who are 85 years of age or older.

On average, the heart pumps out around 70ml of blood with each beat, which is around half the capacity of the left ventricle: this is known as the ejection fraction. When this drops to around 35 per cent or less, it leads to the symptoms of heart failure. It is sometimes classified according to how much it limits physical activity, with Class I used for those who have can carry on their lives as normal, through to Class IV which usually means the patient has symptoms even when resting and cannot exert themselves at all without causing considerable discomfort.

The symptoms of heart failure are usually:

• Tiredness, because less oxygen reaches the body’s tissues
• Shortness of breath, due to blood backing up from the heart as it becomes less efficient and causing fluid to build up in and around the lungs
• Ankle swelling, resulting from the kidneys filtering blood more slowly, which causes fluids to build up – gravity dictates that the extremities will show this first.

Heart failure often starts because of another cardiovascular issue and can trigger a downwards spiral in terms of health as the body tries to deal with the symptoms. Instead, this can inadvertently damage the heart further, in turn causing more problems such as cardiac arrhythmias, depression, kidney disease and sudden cardiac death.

Cardiac arrhythmias

Heart rhythm problems are very common but are not an issue if properly diagnosed and managed. There are several types, including:

• Atrial fibrillation (AF), in which electrical activity in the heart leads to the atria not contracting properly, making the heart beat faster and more irregularly than normal
• Supraventricular tachycardia (SVT), when the heart responds to abnormal electrical activity by speeding up
• Bradycardia, during which the heart beats more slowly than normal. If this is so slow it causes someone to collapse, it is called heart block
• Ventricular fibrillation (VF), when the ventricles quiver rather than contract forcefully, meaning blood is not pumped around the body effectively.

Whether or not an arrhythmia causes symptoms depends on which type it is and how severe the condition is. If they do occur, they may last a few minutes or considerably longer, and happen frequently or only occasionally. Symptoms vary but can include palpitations (being aware of the heart racing), dizziness, tiredness, fainting, chest discomfort and breathlessness.

Practice points

• Contact your nearby GP surgeries, community cardiac services or hospital and identify your local heart failure clinics
• How do they operate and what policies are in place for heart failure drug therapy review and optimisation?
• What local information does your hospital and heart failure service provide to patients?