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Despite beating around 100,000 times per day, most people are not aware of their heart, or all the hard work it is doing. But, sometimes, issues can occur with the heart and circulatory system – and sadly, someone in the UK suffers a heart attack every five minutes.
So, what causes heart conditions? They may be hereditary, but they can be caused by poor lifestyle factors, such as obesity or smoking – giving pharmacy teams the opportunity to help customers with advice and support to safeguard their heart health when it comes to some of the most common cardiac conditions.
Coronary heart disease
Coronary heart disease (CHD) is the most common type of heart and circulatory disease, and the most common cause of premature death in the UK, according to the British Heart Foundation (BHF).
CHD develops slowly over time when coronary arteries become narrowed by a build-up of atheroma, a fatty material within their walls. The pain or discomfort felt from such narrowing is called angina, and if a blockage occurs it can cause a myocardial infarction (heart attack). Angina is a common symptom of CHD, with symptoms such as pain or discomfort in the shoulders, arms, neck, jaw, back or stomach. Other symptoms of CHD include shortness of breath, and feeling faint or sick.
Treatment options may include medications; coronary angioplasty – a procedure that is used to open up narrowed or blocked arteries – with or without a stent; and heart bypass surgery.
Heart attack
A heart attack happens when there’s a sudden loss of blood flow to a part of the heart muscle, and without enough blood and oxygen, the heart can suffer serious damage. There are around 100,000 hospital admissions each year in the UK due to heart attacks, with more than seven out of 10 people surviving.
Heart attack symptoms vary from person to person but can include chest pain or discomfort that happens suddenly and doesn’t go away; or pain that spreads to the left or right arm, or to the neck, jaw, back or stomach. For some people the pain or tightness is severe, while for others it may feel like heaviness, or a burning pain similar to indigestion. Some people may feel sick, sweaty, light-headed or short of breath.
It’s possible to have a heart attack without experiencing all of these symptoms, and the BHF stresses that it’s important to remember pain is experienced differently by each individual, particularly “elderly people or people with diabetes, as the condition can cause nerve damage which affects how they feel pain”.
“Coronary heart disease is the most common cause of premature death in the UK”
Cardiac arrest
Although sometimes mistaken for a heart attack, a cardiac arrest is different – and is when the heart suddenly stops pumping blood around the body. It usually happens without warning, causing the person to collapse suddenly, become unconscious and unresponsive, and breathe abnormally.
Cardiac arrest is caused by a dangerous abnormal heart rhythm (arrhythmia), which happens when the electrical system in the heart isn’t working properly. Not all abnormal heart rhythms are life-threatening, but some mean that the heart cannot pump blood around the body.
Without immediate treatment, the person experiencing cardiac arrest will die. If someone is having a cardiac arrest, phone 999 and start CPR.
As the heart is a muscle, it needs to be exercised regularly through cardio fitness.
Stroke
A stroke happens when blood flow to part of the brain is disrupted, and there are different kinds:
- Ischaemic strokes (‘blood clot strokes’) happen when an artery supplying blood to the brain is blocked by a blood clot
- Haemorrhagic strokes (‘brain bleed strokes’) happen when a blood vessel ruptures, causing a bleed in the brain
- Mini-strokes, or transient ischaemic attacks (TIAs), happen when there’s an interruption in blood flow to part of the brain for a short time causing symptoms such as temporary speech loss. TIA’s usually resolve after a few seconds or minutes.
The acronym FAST has been designed to help recognise the signs of stroke, and stands for:
- Facial weakness – can the person smile? Has their mouth or eye drooped?
- Arm weakness – can the person raise both arms?
- Speech problems – can the person speak clearly and can they understand what you’re saying?
- Time – it’s time to call 999 immediately if you see any of these symptoms.
Factors that increase the risk of having a stroke include having had a previous stroke or heart attack; being aged over 55; having high blood pressure or high cholesterol; having diabetes; or a type of irregular heartbeat called atrial fibrillation (AF).
“There are around 100,000 hospital admissions each year in the UK due to heart attacks”
Tackling poor circulation
Many people develop poor circulation as they get older, and it is also linked to having a heart or circulatory disease, high blood pressure or obesity, and Raynaud’s disease – a common condition where blood stops flowing properly to fingers and toes due to stress or cold temperatures.
The common symptoms of poor circulation are having cold hands and feet; numbness or tingling in the extremities; leg pain or cramps, especially when walking (claudication); swelling in the legs or feet; skin colour changes (pale, blue, or red patches); and slow-healing wounds, especially on the feet.
Jacquie Lee, medication safety officer and information pharmacist at Numark, says: “Pharmacy teams can suggest that customers with poor circulation try strategies such as staying active with walking and gentle leg exercises, avoiding prolonged sitting, having movement breaks every 30 minutes, and include heart-friendly foods within a balanced diet that support circulation, like oily fish, nuts, and leafy greens.”
Jacquie adds that: “Wearing compression hosiery can help with circulation issues in the legs, but they are contraindicated in people with untreated leg ulcers, severe peripheral arterial disease and severe heart failure.” In addition, she says patients should be referred to their GP if they have persistent leg pain or swelling, non-healing wounds or ulcers, skin changes (such as darkening or ulceration); or shortness of breath, dizziness, or chest pain (urgent referral).
Heart failure
Heart failure occurs when the heart is not pumping blood around the body as well as it should, most commonly when the heart muscle has been damaged – for example, after a heart attack.
The main symptoms of heart failure are fainting or feeling lightheaded; feeling increasingly tired or weak at rest which gets worse with movement; a new persistent cough; shortness of breath when active or resting; and swelling in the feet and ankles which can spread to the lower body.
There are many reasons why people may develop heart failure, but the most common causes are damage by a heart attack; disease of the heart muscle called cardiomyopathy; and high blood pressure.
While there is no cure, treatments can help manage symptoms and improve quality of life, such as fitting a pacemaker; heart surgery to improve blood flow to the heart or to repair/replace a faulty valve; and medication to protect and improve heart function.
Arrhythmias
An arrhythmia, or abnormal heart rhythm, usually means the heart is beating too fast, too slow or irregularly, and there are a few different types:
- Atrial fibrillation is the most common irregular, often fast heart rhythm
- Supraventricular tachycardia (SVT) is a very fast heart rhythm
- Atrial flutter is usually a fast heart rhythm where the top chambers of the heart contract at a very fast rate compared to the lower chambers
- Tachybrady syndrome (sick sinus syndrome) causes periods of very fast or slow heart beats
- Heart blocks caused by a delay or blockage between the top and bottom chambers of the heart which can cause a slow heart rate.
The most common symptoms of arrhythmia include palpitations (a thumping or fluttering sensation in the chest), dizziness and feeling faint, breathlessness, chest discomfort, and feeling tired.
Some underlying conditions which could cause an arrhythmia are heart attack or heart failure, cardiomyopathy, and coronary heart disease. Other common triggers of an arrhythmia include viral illnesses, recreational drugs, alcohol, smoking, caffeine, and some OTC and prescription medications.
Common treatments include medication, a heart restarting treatment called cardioversion, or inserting an implantable cardioverter defibrillator (ICD) or pacemaker.
Using an at-home blood pressure monitor can give more accurate readings, as people feel more relaxed and comfortable.
Heart health support in pharmacy
Whatever the case, there is plenty of self care and OTC support that pharmacy teams can offer customers wanting to protect their heart health.
“Pharmacy teams can provide expert advice on lifestyle changes that support heart health,” says George Sandhu, deputy pharmacy superintendent at Well. “[This includes] maintaining a balanced diet, engaging in regular exercise, managing weight and stress, and quitting smoking.”
Stress management and sleep quality are also thought to play a role in protecting heart health. Regular poor sleep is linked to high blood pressure and heart disease, and over time poor sleep can also lead to unhealthy habits including less motivation to be physically active, and unhealthy food choices.
The NHS Community Pharmacy Blood Pressure Check Service (also known as the NHS Community Pharmacy Hypertension Case-Finding Advanced Service) enables community pharmacists to check blood pressure for people aged 40 and over who haven’t been diagnosed with high blood pressure – and pharmacists can also perform blood pressure checks at the request of a general practice, or may offer a private service – such as the PocDoc Healthy Heart Check to assess heart age and cardiovascular disease (CVD). “Of course, anyone with family history of heart disease or experiencing red flag symptoms like chest pain, dizziness, shortness of breath, or numbness in the arms or legs should seek medical attention,” stresses George.
Some OTC products can also be useful for people wanting to look after their heart health. “Pharmacy teams can direct customers to OTC products to help,” adds George, “such as fish oil supplements for heart health, blood pressure monitors for at-home tracking, and cholesterol-lowering supplements”.
Feeling faint, dizzy or having shortness of breath should never be ignored.
Further signposting
While there is much that can be done by pharmacy teams to help people with heart health concerns, Jacquie Lee, medication safety officer and information pharmacist at Numark, says pharmacy teams can also direct customers on to other appropriate services.
“If customers have persistent high blood pressure, chest pain, irregular heartbeats, or breathlessness, pharmacists can refer people to their general practice for diagnosis and management,” she says. “Community pharmacies can also help those aged 40-74 benefit from free heart health assessments as part of NHS Health Checks, and charities and resources such as the British Heart Foundation provide excellent information on lifestyle changes and managing heart conditions. Smoking cessation services are also available through the NHS and locally commissioned services, and there are NHS or local services for diet and exercise support, or private weight management services, including those offered in community pharmacies.”
Through encouraging self care, supporting with diagnoses, and providing face-to-face guidance, community pharmacy teams are the perfect one-stop-expert-shop to help support customers with their heart health.
The BHF information and support pages include heart health questions, information and tips for healthcare professionals: bhf.org.uk/informationsupport.
Details for defibrillators
A defibrillator – also called a defib, a PAD (public access defibrillator) or an AED (automated external defibrillator) – is a device that gives a high energy shock to the heart of someone who is in cardiac arrest to help restart their heart while waiting for the emergency services to arrive.
The British Heart Foundation (BHF) warns that every minute without CPR and a defibrillator after cardiac arrest reduces survival chances by up to 10 per cent, and stresses that “anyone can use a defibrillator”.
Steps to using a defibrillator
Step 1: Press the green button to switch on the defibrillator and follow the instructions
Step 2: Remove the person’s clothing above the waist
Step 3: Peel off the sticky pads and attach them to the person’s bare skin. Put one pad on each side of the chest as shown in the picture on the defibrillator
Step 4: Once you have attached the pads, stop CPR and do not touch the person. The defibrillator will then check the person’s heart rhythm
Step 5: The defibrillator will decide whether a shock is needed. If so, it will tell you to press the ‘shock’ button. An automatic defibrillator will shock the person without you needing to do anything. Do not touch the person while they’re being shocked
Step 6: The defibrillator will tell you when the shock has been given and whether you need to continue CPR
Step 7: If the defibrillator tells you to continue to do CPR, continue with chest compressions until the person shows signs of life, or the defibrillator tells you to stop so it can analyse the heartbeat again.
Further information: defibrillators.bhf.org.uk/resources/choosing-a-defibrillator.
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