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Glossary 

of heart

conditions

ANGINA

Definition

Angina is chest pain that results when there is not enough blood and oxygen supply to the heart.   It occurs when your coronary arteries become narrow over time resulting from a plaque build-up.  Angina is not a disease but a symptom of coronary artery disease and is typically described as heaviness or tightness in the chest.

The condition is classified into stable, unstable and variant angina.

  • Stable (or chronic) angina occurs when the heart is working harder than usual for example during exercise. It has a regular and predictable pattern and symptoms can be relieved by rest and medication.
  • Unstable angina – occurs when at rest and follows an irregular pattern. It is uncommon and more serious as it cannot be relieved by rest or medication and can signal a future heart attack. Unstable angina occurs suddenly and worsens over time.
  • Variant angina (Prinzmetal) – occurs at rest without any underlying coronary artery disease. It is typically due to an abnormal narrowing or spasm of the blood vessels which reduces blood flow to the heart. It can often be relieved by medication. 

 Symptoms

Angina commonly causes pain or discomfort in the centre of your chest. Other symptoms associated include:

  • Pain in your arms, neck, jaw, shoulders and back and on top of chest pain
  • Shortness of breath
  • Nausea
  • Fatigue
  • Sweating
  • Dizziness

It is vital to understand what type of chest discomfort you are experiencing and identify if it is new or changing.

Causes

Angina is usually the result of underlying coronary artery disease although chest pain that mimics angina can be caused by other conditions that are not heart related.

The coronary arteries supply your heart with oxygen-rich blood. However, when too much cholesterol is present in the blood, it leads to a build-up of plaque (fatty material that accumulates in the wall of blood vessels).This causes a narrowing of the blood vessel and, if severe, can reduce blood flow through the artery. This may limit the amount of blood and, therefore, oxygen getting to you heart.

Stable angina is usually caused by physical exertion. The heart demands more blood when you are doing vigorous exercise, but it’s difficult for the heart to get enough blood when your arteries are narrowed. Other factors that can also narrow arteries and trigger angina include emotional stress, cold temperatures and smoking.

Unstable angina occurs when plaque in a blood vessel ruptures (lifts off the artery wall), which leads to the rapid formation of a clot that can stop any blood getting to your heart. If blood flow does not improve it will result in a heart attack.

Variant (Prinzmetal) angina, is caused by a spasm (constriction) in the coronary artery that temporarily narrows the artery and reduces blood flow to the heart. It can occur at rest and is often severe, but can be relieved with medications. 

Diagnosis

It is important to correctly diagnose any chest pain you are experiencing as this can predict your likelihood of having a heart attack. Your doctor will start with a physical exam and discuss symptoms, risk factors and family medical history.

Your doctor may also perform one or more of the following tests to confirm whether you have angina:   

  • Electrocardiogram (ECG or EKG)
  • Echocardiogram
  • Stress test
  • Nuclear stress test
  • Chest X-ray
  • Blood tests
  • Coronary angiography
  • CT scan

Treatment

There are many ways to treat angina, including lifestyle changes, medications and medical procedures. Treatment will help reduce the incidence and severity of symptoms and will help lower your risk of heart attack and death.

However, if you have unstable angina or unusual angina pain, you will need immediate medical treatment.

Lifestyle Changes

  • Quit smoking
  • Weight management
  • Manage diabetes
  • Check cholesterol levels regularly
  • Manage or avoid stress
  • Eat a healthy diet and avoid trans fats and sugar

Medications

If lifestyle changes do not help your angina, your doctor may prescribe the following medications:

  • Nitrates
  • Aspirin
  • Clot-preventing drugs/blood thinners
  • Beta blockers
  • Statins
  • Calcium channel blockers
  • Ranolazine (Ranexa)

Medical Procedures

  • Percutaneous coronary intervention (PCI) - angioplasty and stenting
  • Coronary artery bypass surgery

Prevention

The following lifestyle habits can help prevent angina:

  • No smoking
  • Eat a healthy diet
  • Regular physical exercise
  • Maintain a healthy weight
  • Reduce stress level
  • Monitor and control conditions such as high blood pressure, high cholesterol and diabetes 

Research into Angina 

Arrhythmia

Definition

A heart arrhythmia is an abnormal heart beat or problem with your heart’s natural rhythm. Arrhythmias occur when the electrical signals, which control your heartbeats, do not work properly and cause your heart to beat too fast, too slow or irregularly.

A person with a healthy heart will have a heart rate of between 60 and 100 beats per minute when resting.

Different types of arrhythmias include:

Atrial fibrillation is an irregular and often rapid heart rate. The heart’s top chambers or atria quiver in a rapid and chaotic pattern, which can slow blood flow. The heart’s main pumping chambers, the ventricles, also beat unevenly which affects how well they push blood around the body. The heartbeat of a patient with atrial fibrillation is typically about 150 beats per minute but can reach 350 beats per minute in extreme cases.

Atrial flutter (AFL) is an abnormal rhythm that occurs in the top chambers or atria of the heart. In AFL, the atria beat regularly but too fast, which results in atrial muscle contractions that are faster and out of sync with the lower chambers or ventricles, of the heart. Patients with AFL typically experience heart rates of 150-180 beats per minute at rest, but rarely can reach 300-350 beats per minute.

Supraventricular tachycardia (SVT) is a rapid heartbeat caused by faulty electrical signals in the upper parts of your heart. Patients usually experience a burst of accelerated heartbeats. SVT usually affects young, healthy people, who will experience a heart rate between 160 and 200 beats per minute.

Ventricular tachycardia is an abnormal electrical impulse that begins in the ventricles and causes an irregular fast heartbeat. The ventricle will often contract more than 200 times a minute.

Ventricular fibrillation occurs when rapid and erratic electrical impulses cause the ventricles to quiver instead of pump blood properly. It is life-threatening and is often triggered by a heart attack.

Long QT syndrome (LQT) causes uncoordinated heartbeats which can lead to sudden, uncontrollable and dangerous arrhythmias. LQT syndrome can result in fainting, which typically occurs after increased stress or exercise. Patients with LQT syndrome have an underlying genetic problem.

Bradycardia occurs when your heart beats too slow – under 60 beats per minute. It is a normal phenomenon in people who are very fit (e.g. professional athletes). Bradycardia is however a problem if as a result there is not enough blood reaching your brain, which can cause you to pass out.  

Symptoms

Some patients have no associated symptoms with arrhythmia, while others may notice symptoms but not have a life-threatening arrhythmia.  It is important to have regular check-ups with your GP, especially if you are concerned.

Common symptoms of a heart arrhythmia include:

  •  Fluttering feeling in the chest
  • Racing heartbeat
  • Slow heartbeat
  • Palpitations
  • Dizziness
  • Fainting
  • Light-headedness
  • Chest pain
  • Breathlessness
  • Shortness of breath
  • Sudden or abnormal weakness
  • Sweating  
  • Confusion
  • Trouble concentrating

Causes

There are a number of factors that can cause a heart arrhythmia, including:

  • Heart attack or scarring of the heart tissue from a heart attack
  • Coronary heart disease
  • High blood pressure
  • Smoking
  • Genetics
  • Changes to the heart’s structure e.g. from cardiomyopathy
  • Diabetes
  • Sleep apnea
  • Some medication
  • Alcohol abuse
  • Excessive caffeine consumption
  • Overactive thyroid gland (hyperthyroidism)
  • Underactive thyroid gland (hypothyroidism)
  • Drug abuse
  • Stress

Diagnosis 

To detect an arrhythmia, your doctor will review your symptoms, medical and family history and conduct a physical examination. The following heart-monitoring tests may also be required:

  • Electrocardiogram (ECG)
  • Blood and urine tests 
  • Echocardiogram 
  • Holter monitor 
  • Chest X-ray 
  • Tilt-table test 
  • Electrophysiologic testing (or EP studies)
  • Heart catheterization

Treatment

Treatment is only necessary if symptoms are severe, or if you are at risk of a more serious arrhythmia or complication. Some treatments your doctor may advise include:

  • Pacemaker
  • Medications
  • Cardioversion
  • Catheter ablation
  • Implantable cardioverter-defibrillator (ICD)
  • Surgical procedure to disrupt abnormal electrical circuits (Maze procedure)
  • Coronary bypass surgery
  • Alternative medicine including yoga, meditation or relaxation techniques 

Prevention

If you have an existing heart problem, it is important to do the following:

  • Know the symptoms of arrhythmia and report them to your doctor if they appear
  • Have regular check-ups
  • Maintain your treatment program
  • Take your medication

If you have a normal, healthy heart do the following to keep it in check:

  • Have regular check-ups
  • Know the risk factors of heart disease and arrhythmia
  • Exercise regularly
  • Don’t smoke
  • Eat a healthy diet
  • Maintain a healthy weight
  • Limit caffeine and alcohol consumption
  • Limit or reduce stress

Research into arrhythmia 

Atherosclerosis

Definition

Atherosclerosis is the hardening and narrowing of the arteries in the heart. It is characterised by the build-up of plaque inside the arteries. There are two types of plaques - stable and unstable - which can affect people in different ways.

Stable Plaques

Stable plaques (or lesions) occur when the walls of your coronary arteries, which carry oxygen and nutrients to your heart, become thickened and stiff because of a build-up of fatty deposits. Healthy arteries are elastic and flexible. A person with atherosclerosis will have hardened arteries due to a build-up of fatty substances, particularly cholesterol, which is deposited in the wall of the arteries and may restrict blood flow to the heart.

Atherosclerosis can occur in large arteries throughout your entire body and develops over time. It will often have grave consequences that can lead to heart attack and/or stroke if left untreated.

Unstable Plaques

Unstable plaques can rupture and lead to an acute event such as heart attack, stroke or death without substantial restrictions of blood flow. Unstable plaques are potentially more dangerous than stable plaques as there are no clear symptoms for the former and unstable plaques are also more difficult to diagnose. 

Symptoms

If you have mild atherosclerosis, you may not have any symptoms. Symptoms develop if an artery supplying blood to the heart becomes so narrowed that blood flow is restricted substantially.

Symptoms of moderate to severe atherosclerosis in coronary arteries include:

  • Chest pain or angina
  • Shortness of breath
  • Fatigue or dizziness
  • High blood pressure
  • High blood cholesterol
  • High triglycerides
  • Smoking or tobacco
  • Insulin resistance or diabetes
  • Overweight of obesity
  • Lack of regular exercise
  • Depression
  • Stress
  • Inflammation from diseases such as arthritis, lupus or infections

Causes

The exact cause of atherosclerosis is unknown. Scientists do know that it is a slow progressive disease that can begin as early as childhood. The following may contribute to the disease:

  • High blood pressure
  • High blood cholesterol
  • High triglycerides
  • Smoking or tobacco
  • Insulin resistance or diabetes
  • Overweight of obesity
  • Lack of regular exercise
  • Depression
  • Stress
  • Inflammation from diseases such as arthritis, lupus or infections

Diagnosis 

As a first step, your doctor will conduct a physical exam, to see if they can find narrowed, enlarged or hardened arteries. They may suggest further diagnostic testing such as:

  • Blood tests
  • Doppler ultrasound
  • Ankle-brachial index
  • Electrocardiogram (ECG)
  • Stress test
  • Cardiac catheterization and angiogram
  • CT scan
  • Magnetic Resonance Angiography (MRA)

Treatment

The best treatment for atherosclerosis is to lead a healthy lifestyle. However sometimes medication or surgical procedures are necessary. 

Medications

Some medicine can slow or reverse the effects of atherosclerosis including:

  • Cholesterol medications
  • Anti-platelet medications
  • Beta blocker medications
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Calcium channel blockers
  • Diuretics
  • Other medications 

Surgical Procedures 

People with more severe forms of atherosclerosis may need to have one of the following procedures:

  • Angioplasty and stent placement
  • Endarterectomy
  • Fibrinolytic therapy
  • Bypass surgery

Prevention

Leading a healthy lifestyle is the best way to prevent atherosclerosis. This includes:

  • Eat healthily
  • Don’t smoke
  • Control and maintain a healthy weight
  • Exercise regularly
  • Have regular check-ups
  • Manage unhealthy blood cholesterol
  • Control stress

research into atherosclerosis 

Cardiomyopathy

Definition

Cardiomyopathy is a disease of the heart muscle and prevents the heart from pumping blood around the body properly, which can lead to heart failure. There are four main types of cardiomyopathy. Some are inherited while others are the result of viral infections or heart attacks. These include:

  • Dilated cardiomyopathy affects the left ventricle or main pumping chamber, causing the left ventricle to enlarge and weaken.
  • Hypertrophic cardiomyopathy is an enlarging of the heart muscle cells, causing the walls of the heart to become abnormally thick.
  • Arrhythmogenic right ventricular cardiomyopathy is a disorder that mainly affects the right ventricle. It is characterised by fibro-fatty replacement of the ventricular walls and is often associated with ventricular arrhythmias and can cause sudden death.
  • Restrictive cardiomyopathy affects the walls of the lower ventricles (or heart chambers) making them abnormally rigid and inflexible. This means the ventricles cannot expand as they fill with blood. It is the rarest form of cardiomyopathy. 

Symptoms

The symptoms of cardiomyopathy may include:

  • Breathlessness with exertion or at rest
  • Swelling of the legs, ankles and feet
  • Bloating or inflammation in the abdomen due to fluid build up
  • Fatigue
  • Irregular heartbeats that feel rapid, pounding or fluttering
  • Chest pain
  • Dizziness, light-headedness and fainting

It is important to detect and treat cardiomyopathies as early as possible, regardless of the severity of your symptoms. This may protect the heart from deteriorating rapidly. 

Causes

There are many causes of the various cardiomyopathies but in some cases an underlying cause cannot be identified.

  • Genetic variants. . These may cause cardiomyopathy or affect the susceptibility to cardiomyopathy.
  • Long-term high blood pressure
  • Heart tissue damage from previous heart attack
  • Certain infections which have injured the heart
  • Prolonged rapid heart rate
  • Heart valve problems
  • Metabolic disorder including obesity, thyroid disease, diabetes
  • Nutritional deficiencies
  • Excessive alcohol consumption
  • Drug use
  • Hemochromatosis (an iron build-up in the heart muscle)
  • Pregnancy complications
  • Sarcoidosis (a condition causing inflammation and lumps of cell growth in the heart)
  • Amyloidosis (a build-up of abnormal proteins)
  • Connective tissue disorders

Diagnosis 

To diagnose cardiomyopathy, your doctor will conduct a physical examination, discuss family medical history and review your symptoms. There are several tests patients undergo in order to confirm the diagnosis (and look for underlying causes or other disorders that may have a similar clinical presentation) which may include:

  • Echocardiogram
  • Electrocardiogram (ECG)
  • Treadmill stress test
  • Catheterization
  • MRI
  • CT scan
  • Blood tests
  • Genetic testing

Treatment

Treatment plans depend on the severity and type of cardiomyopathy you have. The goals of a treatment plan are to manage symptoms, prevent the problem from worsening and reduce the risk of complications. More specific treatments include:

Dilated cardiomyopathy 

  • Medications 
  • Surgically implanted devices

Hypertrophic cardiomyopathy 

  • Medications
  • Implantable cardioverter-defibrillator (ICD)
  • Septal myectomy (removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta)
  • Septal ablation (reduces the proportion of tissue blocking the blood flow due)

Restrictive cardiomyopathy

  • Medication
  • Treatment focuses on improving symptoms

If the less invasive approaches listed above are unsuccessful, your doctor may consider the following:

  • Ventricular assist devices (VADs)
  • Heart transplant

Prevention

In many cases, cardiomyopathy is difficult to prevent, especially if you have a family history of the condition. To help reduce your chance of developing the heart disease you can:

  • Avoid excessive alcohol
  • Avoid drug use
  • Manage high blood pressure, high cholesterol and diabetes
  • East a healthy diet
  • Eat less salt
  • Exercise Regularly
  • Reduce stress levels
  • Regular sleep

Research into cardiomyopathy 

Congenital Heart Disease

Definition

Congenital heart disease or childhood heart disease is a collective term for structural abnormalities of the heart, aorta, or other large blood vessels which are present at birth. Congenital heart defects change the normal flow of blood to the heart. CHD is the most common form of birth defect in Australia, affecting up to 1 in 100 live-born babies.

There are many types of CHD and the severity varies in every baby. Some defects are simple and do not require treatment, while others are more complex or life-threatening, and may require multiple surgeries over many years.

CHD is classified into the following major categories:

  • Holes in the heart may form in the septum (wall that separates the heart chambers) or between the major blood vessels. A hole will allow oxygen-rich and oxygen-poor blood to mix. If a lot of blood is mixed due to large holes in the heart, the blood circulated around the child’s body will not carry enough oxygen. This is commonly referred to as blue baby syndrome.
  • Obstructed blood flow occurs when blood vessels or heart valves are narrower than normal due to a heart defect. When this happens, the heart muscle needs to work harder in order to pump blood through the valves and around the body. This can eventually lead to thickening or enlarging of the heart.
  • Abnormal blood vessels occur when the blood vessels going to and from the heart do not form properly or are not positioned correctly, leading to a variety of heart defects. This ultimately affects the flow of oxygen-rich blood from the heart to the rest of the body.
  • Heart valve abnormalities occur when heart valves cannot open and close properly, and oxygen-rich blood cannot flow easily to the rest of the body.
  • An underdeveloped heart can occur when a major portion of the heart does not develop properly in the womb. As a result, the heart will not be able to work properly.
  • A combination of defects can occur when babies are born with more than one heart defect which may have grave consequences for the child.

Types of CHD include:

  • Aortic Stenosis (AS)
  • Atrial Septal Defect (ASD)
  • Coarctation of the Aorta (CoA)
  • Transposition of the Great Arteries (TGA)
  • Ebstein's Anomaly
  • Patent Ductus Arteriosis (PDA)
  • Pulmonary Stenosis
  • Tetralogy of Fallot
  • Total Anomalous Pulmonary Venous Return (TAPVR)
  • Truncus Arteriosus (TA)
  • Ventricular Septal Defect (VSD)
  • Hypoplastic Left Heart Syndrome (HLHS) Double Outlet Right Ventricle (DORV)

Symptoms

Serious cases of CHD are usually evident immediately after birth or during the first few months of life. Symptoms may include:

  • Cyanosis – pale grey or blue skin colour
  • Quick breathing
  • Flared nostrils
  • Grunting when breathing
  • Swelling in the legs, abdomen or around the eyes
  • Shortness of breath during feeding which can lead to poor weight gain

Congenital heart defects that are less serious may not present until later in childhood. These symptoms can include:

  • Shortness of breath during exercise or activity
  • Tiring easily during exercise or activity
  • Swelling in the hands, ankles, or feet

Causes

The heart is the first organ to form in the body and starts to develop when an embryo is the size of a sesame seed. Within the first six weeks of pregnancy, the heart begins to take shape and starts beating. During this time, the major blood vessels that run to and from the heart also begin to form. At this critical point in development, heart defects may occur.

80 per cent of CHD cases remain unsolved which means doctors have no idea what caused them. Some of the known causes include:

  • Genetic mutations affecting single genes, multiple genes contained within copy number duplications or deletions, or chromosomal abnormalities with or without syndromic association
  • Maternal illness during pregnancy
  • Medication or drugs. Some over the counter, prescription or illicit drugs may increase the risk of CHD
  • Alcohol consumption during pregnancy
  • Parental health – factors such as unmanaged diabetes or poor nutrition may increase the risk
  • Environmental factors such as smoking and hypoxia (O2 deficiency)
  • Maternal age 

Diagnosis

Severe heart defects are usually diagnosed during pregnancy or shortly after birth. Minor defects often have no signs and children are generally diagnosed when they are older. In addition to a regular physical exam, tests to diagnose CHD may include:

  • Foetal echocardiogram
  • Echocardiogram
  • Electrocardiogram
  • Chest X-ray
  • Pulse oximetry (test used to measure the oxygen level of the blood)
  • Catheterization 

Treatment

Treatments for heart defects vary according to the type of CHD. Defects that are very minor may have no long-term effects and can safely go untreated. In some instances they may even correct themselves as the child ages.

However other defects are more life-threatening and require treatment as soon as diagnosed. Treatment for these defects may require one or more of the following:

  • Procedures using catheterization
  • Open-heart surgery
  • Heart transplant
  • Medications

Children who have serious and complex heart defects are likely to require lifelong monitoring and treatment. Many will also need multiple surgeries, exercise restrictions, and infection prevention such as antibiotics.    

Prevention

Because eight out of ten cases of CHD have unknown cause, it is often not possible to prevent these conditions. However, there are ways you can reduce your child’s risk of overall birth defects:

  • Vaccinate against Rubella (German measles) as the infection, during pregnancy, may affect a baby’s heart development
  • Manage chronic medical conditions like diabetes and high blood pressure
  • If you require medication for existing conditions, consult your doctor
  • Avoid harmful substances while pregnant such as strong cleaning products, smoking, or alcohol
  • Take a multivitamin with folic acid and vitamin B3

Research in congenital heart disease 

Coronary Heart Disease

Definition

When the major blood vessels (coronary arteries) that supply your heart with blood, oxygen and nutrients become damaged or diseased, this is called coronary heart disease.

The arteries become damaged when there is a cholesterol build-up, which eventually turns into plaque. This narrows the arteries and decreases blood flow to your heart. If coronary artery disease is not treated and an artery becomes completely or even partially blocked, it will often result in a heart attack.

Symptoms

When your coronary artery narrows, it is unable to supply enough oxygen-rich blood to the heart. The most common symptoms you will experience are:

  • Chest pain (angina)
  • Shortness of breath
  • Heart attack

Causes

Research shows that coronary heart disease begins when the inner layers of the coronary arteries are damaged. These include but are not limited to:

  • Smoking
  • High blood pressure
  • High cholesterol
  • High levels of sugar in the blood e.g. diabetes or insulin resistance
  • Lack of exercise
  • Blood vessel inflammation

If the inner walls of an artery are damaged, a plaque build-up (made up of cholesterol) will accumulate where the artery has been injured. This process is called atherosclerosis. Overtime, the plaque will harden. If the plaque ruptures, blood cells called platelets will try to repair the injured section but may clump together and cause a blood clot, which can lead to a heart attack. 

Diagnosis 

In order to diagnose coronary heart disease, a doctor will ask questions about your personal and family medical history, order blood tests and conduct a physical examination. Further testing may be required which can include:

  • Electrocardiogram (ECG)
  • Echocardiogram
  • Stress test
  • Cardiac catheterization or angiogram
  • Heart scan

Treatment

If you are diagnosed with coronary heart disease your doctor may advise you to make lifestyle changes. Depending on the severity, you may also need to take certain medications or have a procedure to improve the problem.

Lifestyle changes:

  • Quit smoking
  • Eat a healthy diet
  • Exercise regularly
  • Maintain a healthy weight
  • Reduce stress

Medication:

  • Cholesterol managing drugs including statins
  • Aspirin
  • Beta blockers
  • Nitroglycerin
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)

Medical procedures

  • Percutaneous coronary intervention (PCI) - angioplasty and stent insertion
  • Coronary artery bypass surgery

Prevention

To reduce the likelihood of developing coronary heart disease, you can do the following:

  • Keep your blood pressure in check
  • Monitor your cholesterol level and take medication if it is high
  • Remain in a healthy weight range
  • Quit smoking
  • Manage stress levels
  • Eat a healthy diet
  • Exercise regularly

There are some risk factors of coronary heart disease that cannot be controlled. These include age, gender and family history. It is important to find out whether you have a family history of coronary heart disease and have regular check-ups with your doctor if you do. 

Research into Coronary Heart Disease 

Heart Attack

Definition

A heart attack results when an artery that supplies oxygen to the heart is suddenly blocked, starving the heart of oxygen. When this occurs, the heart muscle cells begin to die and the longer the heart is without oxygen, the more permanent the damage.

Symptoms

Heart attack symptoms vary for each person and can be especially different for men and women. Some people experience mild pain or no warning signs before a heart attack, while others undergo serious symptoms weeks or days in advanced.

The most common heart attack symptoms include:

  • Pressure, tightness or pain in the chest and arms which may spread to the neck, jaw or back
  • Nausea
  • Indigestion or heartburn
  • Cold sweat
  • Fatigue
  • Light-headedness or sudden dizziness

Heart attack warning signs can be different for women. Some common symptoms include:

  • Nausea or vomiting
  • Extreme fatigue
  • Fainting
  • Cold sweats
  • Pressure in upper back
  • Light-headedness
  • Dizziness

Causes

A heart attack occurs when one or more of your coronary arteries become blocked and starves your heart of oxygen.

Coronary arteries carry oxygen-rich blood to the heart. If there is a build-up of fatty substances and cholesterol, the arteries will begin to narrow making it harder for oxygen to reach the heart.

Over time, these fatty substances harden and eventually become plaque. If the plaque ruptures, blood cell fragments known as platelets usually stick to the side of the artery that has been injured and can clump together to form blood clots. If a large clot forms, it can block a coronary artery which will result in a heart attack.

The major risk factors that cause a heart attack are:

  • Unhealthy blood cholesterol
  • High blood pressure
  • Smoking
  • Insulin resistance
  • Diabetes
  • Overweight or obesity
  • Metabolic syndrome
  • Lack of physical activity
  • Poor diet high in saturated or trans fats, cholesterol, sodium and sugar
  • Old age
  • Family history of coronary heart disease, unhealthy cholesterol and high blood pressure

Diagnosis 

If you are suffering from a heart attack, you need urgent medical attention at a hospital. A doctor will check your blood pressure, pulse and temperature and assess your symptoms.

Immediate tests which help to indicate if you are having a heart attack (and the degree of damage) include:

  • Electrocardiogram (ECG)
  • Blood tests
  • Chest X-ray
  • Coronary catheterisation (angiogram)
  • Exercise stress test
  • CT scan
  • MRI

Treatment

The main way to prevent further damage during a heart attack is to restore blood flow to the heart quickly. The faster this happens, the less heart muscle cells will die, which is important as they cannot be repaired of regenerated after injury.

Medications

  • Aspirin
  • Thrombolytics
  • Antiplatelet agents
  • Other blood-thinning medications
  • Pain relievers
  • Nitroglycerin
  • Beta blockers
  • ACE inhibitors

Surgical procedures

  • Coronary angioplasty and stenting
  • Coronary artery bypass surgery

Prevention

You should have regular physical exams by your doctor to test risk factors, in order to prevent a heart attack from occurring. 

Leading a healthy life is the main way to avoid a heart attack. You must also know your family history and if you have unhealthy blood cholesterol levels or high blood pressure, take the appropriate preventative medication recommended by your doctor.

Lifestyle changes include:

  • Avoid smoking
  • Control blood pressure (with medication if it is high)
  • Control unhealthy blood cholesterol through diet or medication
  • Exercise regularly
  • Maintain a healthy weight
  • Eat a healthy diet
  • Manage diabetes
  • Control stress
  • Drink alcohol in moderation
  • Get regular medical check-ups 

Research into heart attacks 

Heart Failure

Definition

Heart failure (or congestive heart failure) is a serious condition where the heart has difficulty pumping enough blood around the body. It occurs when the heart muscle becomes too weak or stiff to pump blood effectively.

Heart failure can be ongoing (chronic) or may start suddenly (acute).

The four types of heart failure include:

  • Left-sided heart failure (a fluid build-up in your lungs causing shortness of breath)
  • Right-sided heart failure (a fluid build-up in your abdomen, legs and feet causing swelling)
  • Systolic heart failure (a pumping problem affecting the left ventricle)
  • Diastolic heart failure (a filling problem as the left ventricle cannot relax or fill fully)

Symptoms

Signs of heart failure may include:

  • Shortness of breath during activity or at rest
  • Fatigue
  • Weakness
  • Swelling in your legs, ankles and feet
  • Rapid or irregular heartbeat
  • Reduced ability to exercise
  • Persistent coughing or wheezing, with blood-tinged phlegm
  • Increased need to urinate at night
  • Abdomen swelling
  • Sudden weight gain from fluid retention
  • Lack of appetite
  • Nausea
  • Difficulty concentrating or decreased alertness
  • Sudden, severe shortness of breath
  • Chest pain (if your heart failure is caused by a heart attack)

Causes

Heart failure generally develops after other conditions have damaged or weakened your heart. However, sometimes heart failure can occur suddenly if the heart muscle becomes too stiff. The following conditions can damage or weaken your heart and can lead to heart failure:

  • Coronary artery disease and heart attack
  • High blood pressure (hypertension)
  • Faulty heart valves
  • Damage to the heart muscle (cardiomyopathy)
  • Myocarditis, an inflammation of the heart muscle commonly caused by a virus
  • Congenital heart defects
  • Heart arrhythmias
  • Other diseases such as diabetes, obesity, HIV, hyperthyroidism, hypothyroidism, or a build-up of iron or protein

Diagnosis 

To diagnose heart failure, your doctor will discuss your medical history, review your symptoms, check for risk factors and may perform a physical examination. These can include:

  • Using a stethoscope to listen for signs of congestion or abnormal heart sounds
  • Blood tests
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Stress test
  • Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI)
  • Coronary angiogram
  • Myocardial biopsy

Treatment

In the majority of cases, heart failure is a chronic disease that needs ongoing treatment in order to help you live longer and reduce your chance of sudden death.

In some rare cases, doctors may be able to reverse heart failure by treating the underlying cause, like repairing a heart valve or managing a heart rhythm.

The common treatments to help reduce symptoms of heart failure include:

Medication

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers
  • Beta blockers
  • Diuretics
  • Aldosterone antagonists
  • Intropes
  • Digoxin (Lanoxin)

Surgical and medical devices

  • Coronary bypass surgery
  • Heart valve repair or replacement
  • Implantable cardioverter-defibrillators (ICDs)
  • Cardiac resynchronization therapy (CRT), or biventricular pacing
  • Heart pumps

If your heart failure becomes too severe the only option may be a heart transplant. Heart transplants can dramatically improve your quality and length of life. If the operation is successful and your body accepts the new organ, patients need to be on lifelong anti-rejection medication and must live a healthy life post-surgery. 

Prevention

Making lifestyle changes to reduce or eliminate the risk factors, is the best way to prevent heart failure. These include:

  • Quit smoking
  • Control medical conditions such as high blood pressure, diabetes, obesity
  • Eat a healthy diet
  • Maintain a healthy weight
  • Stay physically active
  • Reduce or manage stress levels
  • Restrict your salt intake
  • Monitor your blood cholesterol
  • Reduce sugar intake
  • Limit alcohol intake
  • Get plenty of sleep

Research into heart failure 

Research into heart failure 

High Blood Pressure (Hypertension)

Definition

Blood pressure is the force of blood pushing against your artery walls as it flows through your heart. It is determined by the amount of blood pumped by your heart and the amount of resistance to blood flow in your arteries. Therefore, the narrower your arteries are and the more blood your heart pumps, the higher your blood pressure will be.

 Arteries carry oxygen-rich blood from the heart to the rest of the body. If you have high blood pressure (or hypertension) it will eventually lead to more serious health problems.

Symptoms

Around 4 million Australians suffer from hypertension and of these, more than two thirds have uncontrolled or unmanaged high blood pressure.

 Unfortunately most people with hypertension, even those with dangerously high levels, have no signs or symptoms. A few people may suffer from headaches, shortness of breath or nosebleeds. However these signs may not result until hypertension has reached a life-threatening stage.

Causes

There are two types of hypertension:

  • Primary (essential) hypertension
  • Secondary hypertension

This type of high blood pressure usually develops gradually and in most cases, there is no known cause.

This hypertension is caused by an underlying condition and generally appears suddenly, causing higher blood pressure than primary hypertension. Some conditions which may lead to secondary hypertension include:

  • Obstructive sleep apnoea
  • Kidney problems
  • Adrenal gland tumours
  • Thyroid problems
  • Defects in blood vessels that you are born with
  • Certain medications such as birth control pills, cold remedies, congestants, over-the-counter pain relievers, some prescription drugs
  • Illegal drugs
  • Alcohol abuse or chronic alcohol use

Diagnosis 

Measuring blood pressure is very straightforward and can be done with your doctor. Your doctor will place an inflatable cuff around your arm and use a pressure measuring gauge. The reading has two numbers. The first number (systolic pressure) measures the pressure in your arteries when your heart beats. The second (diastolic pressure) measures the pressure in your arteries between beats.

The measurements fall into four general categories:

  • Normal blood pressure: A normal reading is below 120/80 mm Hg
  • Prehypertension: A systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time
  • Stage 1 hypertension: A systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99mm Hg
  • Stage 2 hypertension: Severe hypertension. Stage 2 is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher

Before being diagnosed with high blood pressure, your doctor will take two to three readings as it can vary throughout the day. 

Treatment

Lifestyle changes are an important way to control hypertension. These include:

  • Eating a healthy diet
  • Reducing salt intake
  • Limiting alcohol intake
  • Regular exercise
  • Not smoking
  • Maintaining a healthy weight

However if lifestyle changes are not enough to manage hypertension, doctors may prescribe the following medications:

  • Thiazide diuretics
  • Beta blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Calcium channel blockers
  • Renin inhibitors

Additional medications also used to treat hypertension include:

  • Alpha blockers
  • Alpha-beta blockers
  • Central-acting agents
  • Vasodilators
  • Aldosterone antagonists

Prevention

If your hypertension is hereditary, it is important to combine a healthy lifestyle with the appropriate medication recommended by your doctor, in order to keep it under control. Ultimately leading a healthy lifestyle is the best way to reduce or prevent hypertension:

  • Eat a healthy diet
  • Reduce salt intake
  • Limit alcohol intake
  • Exercise regularly
  • Don’t smoke
  • Maintain a healthy weight
  • Reduce or manage stress levels

Research into high blood pressure 

research into high blood pressure 

High Cholesterol

Definition

Cholesterol is a waxy substance that is made by the liver and obtained through the diet. It can be found in the fats (lipids) in your blood. There are two different types of cholesterol including:

  • Bad Cholesterol (low-density lipoprotein or LDL) which carry cholesterol particles throughout your body. LDL cholesterol is bad because it builds up in the walls of your arteries, making them hard and narrow which can increase the risk of a heart attack.
  • Good Cholesterol (high-density lipoprotein or HDL) which picks up excess cholesterol and takes it back to the liver. Having high HDL is linked to lower risk of heart disease, heart attack and stroke.

 Cholesterol is essential in order for your body to continue building healthy cells, however having high cholesterol can increase your risk of heart disease. This is because it can lead to a build-up of fatty deposits in your blood vessels, which overtime can make it difficult for enough blood to flow through your arteries and consequently to your heart.

Symptoms

There are no symptoms of high cholesterol. The only way to detect it is through a blood test. High cholesterol can be inherited or is the result of unhealthy lifestyle choices. The best way to control high cholesterol is through a healthy diet, regular exercise and medication. 

Causes

High cholesterol can be caused by a number of things including:

  • Unhealthy diet, particularly high in saturated fats, trans-fats and sugar
  • Overweight or obesity
  • Lack of exercise
  • Age (cholesterol starts to rise after the age of 20)
  • Smoking
  • Family history 

Diagnosis 

A blood test, specifically a lipid panel or lipid profile, will show your cholesterol levels. The test will report your total cholesterol level, LDL cholesterol, HDL cholesterol and triglycerides (a type of fat in the blood). For an accurate reading you should not eat or drink anything between nine and twelve hours before the sample is taken.

In Australia, cholesterol levels are measured in millimoles per litre (mmol/L).

The range below is a guide for a healthy blood cholesterol level.

Total cholesterol should be between: 3.9 – 5.5 mmol/L

HDL (good cholesterol) should be between: 0.9 – 2.1 mmol/L

LDL (bad cholesterol) should be between: 1.7-3.5 mmol/L

Triglycerides should be between: 0.5 – 1.7 mmol/L

Treatment

Leading a healthy lifestyle through exercise and a healthy diet is important to avoid high cholesterol. If your cholesterol levels remain high, your doctor may recommend medication to help reduce the level. These include:

  • Statins
  • Bile-acid binding resins
  • Cholesterol absorption inhibitors
  • Injectable medication (a new class of drugs which can help the liver absorb more LDL cholesterol)

If you have high triglycerides, your doctor may recommend the following:

  • Fibrates
  • Niacin
  • Omega-3 fatty acid supplement

Prevention

To help prevent cholesterol you can:

  • Eat a healthy diet
  • Reduce salt
  • Limit consumption of animal fats
  • Eat healthy fats like avocados and salmon to increase HDL levels 
  • Avoid trans fats found in fried foods and baked goods
  • Eat whole grains where possible
  • Drink alcohol in moderation
  • Lose excess weight
  • Exercise regularly
  • Quit smoking
  • Know your family history 

Research into high cholesterol 

Ischemic Heart Disease

Definition 

Ischemic heart disease is a result of coronary heart disease. 

The heart muscle can become weakened as a result of severe plaque build-up in the heart arteries, causing damage to the heart muscle. Once that tissue is necrotic or dead, it can not pump like it once did.

For further information, refer above to coronary heart disease. 

research into ischemic heart disease 

research into ischemic heart disease 

research into ischemic heart disease 

Obesity

Definition

Obesity is a complex, chronic disorder and a number of genetic and lifestyle factors have been found to contribute to the condition. Excess body weight increases your risk of a number of diseases and health problems including heart disease, diabetes and high blood pressure. If someone is obese, their heart is working harder to pump blood around their entire body which puts pressure on the organ.

The distribution of fat is also important when assessing obesity. For example; abdominal obesity is related to a higher risk of cardiovascular disease and type 2 diabetes.

Symptoms

People with a body mass index (BMI) of 25 or more are classified as overweight. People with a BMI of 30 or greater are classified as obese.

Your BMI is calculated by dividing your weight (in kilograms) by the square of your height (in metres). For example: if you weight 90 kg and are 1.8 m tall then your BMI = 90/1.8^2 = 25. The ranges below show healthy, at risk and unhealthy BMI levels:

Underweight = Below 18.5 BMI

Normal = 18.5 – 24.9 BMI

Overweight = 25.0 – 29.9 BMI

Obese (Class I) = 30.0-34.9 BMI

Obese (Class II) = 35.0 – 39.9 BMI

Extreme obesity (Class III) = 40.0 and above BMI

Causes

Obesity occurs when you consume more calories than you burn. While there are genetic, behavioural and hormonal influences that can affect body weight, the main causes of obesity are:

  • Inactivity: If you’re not active and have a sedentary lifestyle, you will not burn as many calories as you consume through exercise or normal daily activities.
  • Unhealthy diet and eating habits: If you have an unhealthy diet full of junk food and/or soft drinks or high calorie drinks, weight gain is inevitable.

 Diagnosis 

The best way to detect whether you are obese is to calculate your BMI. If you are in the obese range, your doctor may want to perform some further tests to determine how much weight you need to lose and what health conditions you are at risk of. These tests include:

  • Taking your health history
  • Doing a general physical exam
  • Measuring your waist circumference
  • Checking for other health problems like high blood pressure or diabetes
  • Blood tests

Treatment

The goal of obesity treatment is to lose and maintain a healthy weight. All reputable weight-loss programs require lifestyle changes through eating habits and physical activity and will be tailored to suit individual needs. Treatment tools include:

  • Dietary changes
  • Increase in physical exercise
  • Behaviour therapy such as counselling or support groups
  • Weight loss surgery (this is a last resort) 

Prevention

It is important to be mindful of the ways you can prevent excess weight gain whether you are a healthy weight or at risk of obesity. The steps to prevention include:

  • Exercise regularly
  • Eat a healthy diet
  • Avoid foods and beverages high in saturated fats, trans-fats and sugar
  • Monitor your weight 

research into obesity 

Rheumatic Heart Disease

Definition

Rheumatic heart disease (RHD) occurs when the heart valves are damaged as a result of acute rheumatic fever. If you suffer from RHD, blood cannot flow to your heart properly as your heart valves have trouble opening and closing.

 Rheumatic heart disease is very prevalent in remote Aboriginal and Torres Strait Islander communities where acute rheumatic fever is common.

Symptoms

You may not always have symptoms if you have rheumatic heart disease. However some warning signs include:

  • Breathlessness in activity
  • Chest pain
  • Fainting
  • Fever related to infection of damaged heart valves
  • Heart palpitations
  • Stroke
  • Swelling
  • Trouble breathing when lying down
  • Waking from sleep and needing to sit or stand up

Causes

Rheumatic heart disease is caused by acute rheumatic fever or recurring rheumatic fever which has been left untreated.

Acute rheumatic fever is an inflammatory disease that develops if strep throat or scarlet fever – an infection with Group A streptococcus bacteria – is left untreated without antibiotics. Acute rheumatic fever is prevalent in developing nations or disadvantaged communities and most common among 5-15 year olds.

If you are susceptible you may experience an immune response if your strep throat is not addressed. This response can then target the brain, skin, joints and heart and may cause inflammation.

Diagnosis 

To diagnose rheumatic heart disease, your doctor may conduct one of the following tests:

  • Physical examination
  • Medical history to check for past       acute rheumatic fever or strep infection
  • Chest X-ray
  • Electrocardiogram (ECG) Echocardiogram

Treatment

The type of treatment will depend on the severity of the rheumatic heart disease. Some options include:

  • Medication to treat infection
  • Balloons inserted through a vein to open up a valve
  • Blood-thinning medicine to prevent stroke or to prepare for a heart valve replacement
  • Heart valve surgery to repair or replace damaged heart valves
  • Heart transplant 

Prevention

Rheumatic heart disease and acute rheumatic fever are both entirely preventable.

Antibiotic treatments including penicillin to treat strep throat can dramatically reduce the risk of acute rheumatic fever and consequently rheumatic heart disease.

If you have acute rheumatic fever, prompt diagnosis from your doctor is essential, combined with the appropriate medication, in order to prevent it from worsening and deteriorating into heart disease.

In some cases, you may need to continue taking preventative antibiotics such as prophylactic antibiotics for many years after acute rheumatic fever. This will be decided by your doctor who will consider the severity of your situation.

Spontaneous coronary artery dissection

Definition

Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that results when an inner layer of one of the blood vessels in the heart tears. Blood seeps between the artery layers, forms a blockage and can slow or block blood flow to the heart, causing angina, heart attack, abnormalities in heart rhythm or sudden death. 

Women in their 40s and 50s are most at risk of SCAD, although it can occur at any age and also in men. The majority of people who develop SCAD are often healthy with no known risk factors of heart disease such as high blood pressure, diabetes or high blood cholesterol.

Symptoms

Signs and symptoms of spontaneous coronary artery dissection may vary from mild discomfort in the chest to common heart attack warning signs. If you experience any of the below, it is best to seek medical advice immediately:

  • A rapid heartbeat or fluttery feeling in your chest
  • Chest pain
  • Dizziness
  • Nausea
  • Pain in your arms, shoulders or jaw
  • Shortness of breath
  • Sweating
  • Unusual or extreme tiredness

Causes

Spontaneous coronary artery dissection (SCAD) is a very rare condition and not enough medical research has been done into the disease, so the causes are largely unknown. However it is likely that a combination of factors trigger SCAD. These include:

  • Blood vessel changes
  • Sex hormone changes
  • Blood volume changes
  • Changes in women related to pregnancy or menopause
  • For men and women, extreme exertion and extreme stress appear to play a role
  • Intravascular ultrasound
  • Optical coherence tomography
  • CT scans

Diagnosis 

To diagnose spontaneous coronary artery dissection, your doctor may order the following tests after reviewing your symptoms:

  • Coronary angiogram
  • Intravascular ultrasound
  • Optical coherence tomography
  • CT scans

A major challenge in diagnosing SCAD is getting health care practitioners to see beyond the young, seemingly healthy individual, as they are not stereotypical patients at risk of a heart attack.

Treatment

The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to the heart. Treatment plans will depend on the severity of your condition including the size and location of the tear. Medication may include:

  • Inserting a stent to hold the artery open
  • Surgery to bypass the damaged artery
  • Medications such as aspirin, blood-thinning drugs, blood pressure drugs or medications to control chest pain, cholesterol drugs, beta blockers
  • Cardiac rehabilitation program
  • Checking and monitoring weaknesses in other blood vessels

Prevention

Because there has been very little research into spontaneous coronary artery dissection (SCAD) and the causes are still unknown, there is no scientifically proven way to prevent SCAD from occurring.

It is best to keep your heart healthy and follow advice regarding general heart disease prevention, such as:

  • Regular exercise
  • Eat a healthy diet
  • Not smoking
  • Moderate alcohol consumption
  • Manage stress levels
  • Control blood pressure, blood cholesterol and sugar levels

Research into SCAD

Cardiovascular diseases remain the leading cause of premature death and disability in our society. To address this issue requires mechanistic insights into disease pathophysiology. One form of cardiovascular disease, which was thought to be rare but recently has been found to be the cause of 2-4% of all cases presenting with acute coronary syndrome (ACS) and to account for up to 24% of cases of myocardial infarction (MI) in women aged <50 yr, is spontaneous coronary artery dissection (SCAD). 

SCAD is a non-atherosclerotic disease of coronary arteries that presents as an ACS or sudden death in younger women (45 – 52 yr), who are not overweight and have a low incidence of traditional risk factors, and can occur in families. It has also recently been strongly associated with fibromuscular dysplasia (FMD) with 45-86% of cases having been found to have non-coronary FMD on routine screening. Given that both conditions are uncommon, this suggests that SCAD and FMD are pathophysiologically linked. Of interest, a genetic association study of FMD in patients of European ancestry recently identified an intronic variant in the phosphatase and actin regulator 1 gene (PHACTR1), involved in angiogenesis and cell migration, with higher PHACTR1 expression in primary cultured fibroblasts of FMD risk allele carriers compared to non-carriers.

We have recently reported on the outcomes of the first 40 of now almost 200 SCAD patients that we have accumulated, including six families with more than one affected, most of whom were accrued as a result of a social media survey. FMD was identified in 7 (37%) of 19 patients screened. Interestingly, migraine was identified in 43% of the 40 cases, a prevalence that is similar to previous reports of SCAD (37.5% cases) and FMD (32.2% cases) and considerably higher than in the general population (12%, P<0.001). Accordingly, we hypothesise that SCAD is due to a genetic susceptibility resulting from variants in the phosphatase and actin regulator 1 gene (PHACTR1), or in genes in functionally related pathways, involved in angiogenesis and cell migration. 

Further, we hypothesise these variants result in a systemic vascular process with both structural endothelial vulnerabilities and impaired vasomotor tone as possible mechanisms for both SCAD and migraine development, which is commonly observed in SCAD suffers, via altered functions of PHACTR1 or pathway-related proteins. Accordingly, we are currently undertaking genetic, genomic and cell biology studies to test these hypotheses in our cohort of SCAD patients. 

Research into SCAD

Stroke

Definition

A stroke affects the arteries leading to and within the brain. When a stroke occurs, the blood supply to a part of the brain is either blocked by a clot or ruptures, which deprives the brain of oxygen and nutrients, and causes brain cells to die.

Symptoms

If the following signs occur, seek immediate medical health and note when the symptoms started:

  • Trouble speaking and understanding or confusion
  • Paralysis or numbness of the face, arm or leg
  • Trouble with seeing in one or both eyes
  • Headache which is sudden and severe, followed by vomiting and dizziness
  • Trouble walking

Causes

High blood pressure (hypertension) is the most important known risk factor for stroke. High blood pressure can damage blood vessel walls and overtime, this may lead to a stroke.

The other major lifestyle risk factors that can be controlled include:

  • High blood cholesterol
  • Smoking
  • Obesity or being overweight
  • Poor diet and lack of exercise
  • High alcohol consumption

A stroke can occur in two main ways. It can either be caused by a blocked artery or the bursting of a blood vessel.

Ischaemic stroke

Approximately four out of five strokes are ischaemic. This occurs when the arteries to the brain become narrowed or blocked, severely reducing blood flow to the brain. The two common ischaemic strokes are:

  • Thrombotic stroke which occurs when a blood clot forms in one of the arteries that supplies blood to the brain. A clot may form by fatty deposits or plaque, which builds up in the arteries, also known as atherosclerosis, and cause reduced blood flow.
  • Embolic stroke which occurs when a blood clot forms outside of the brain and is then carried through the bloodstream and lodges in a narrower brain artery. These clots are commonly formed in the heart.

Haemorrhagic stroke

Around one in every five strokes is haemorrhagic. A haemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing blood to leak into the brain. The two common types of haemorrhagic stroke include:

  • Intracerebral haemorrhage which can be caused by longstanding high blood pressure, trauma, vascular malformations or use of blood-thinning medications.
  • Subarachnoid haemorrhage, commonly caused by an aneurysm, which is a weak or thin spot on a blood vessel wall.

Transient ischaemic attack

A transient ischaemic attack (TIA) or “mini stroke” has the same symptoms as a stroke but these disappear within 24 hours. The causes are similar to that of a stroke and a TIA should be regarded as a warning sign, as approximately one in five people who have a TIA will have a major stroke within the next three months.

Diagnosis 

To determine the possible type of stroke, and the area of the brain most affected, doctors may need to run the following tests:

  • Physical examination
  • Blood tests
  • CT scan
  • MRI
  • Carotid ultrasound
  • Cerebral angiogram
  • Echocardiogram

Treatment

Treatment will depend on the type of stroke experienced.

Ischaemic stroke 

To treat an ischaemic stroke, doctors need to restore blood flow to the brain quickly. Doctors may do this through:

  • Medication e.g. aspirin, intravenous injection of tissue plasminogen activator
  • Medications delivered directly to the brain
  • Mechanical clot removal
  • Carotid endarterectomy
  • Angioplasty and stents

Haemorrhagic stroke

Treatment of a haemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain. Doctors may need to do the following:

  • Surgical blood vessel repair
  • Surgical clipping
  • Coiling (endovascular embolization)
  • Surgical AVM removal
  • Intracranial bypass
  • Stereotactic radiosurgery

Stroke recovery and rehabilitation

Every patient’s recovery differs and depends on the condition. Treatment may include:

  • Seeing a neurologist (doctor trained in brain conditions)
  • Seeing a rehabilitation doctor 
  • Nurse
  • Dietician
  • Physical therapist
  • Occupational therapist
  • Recreational therapist
  • Speech therapist
  • Social worker
  • Case manager
  • Psychologist 

Prevention

A stroke can happen to anyone. Certain unchangeable factors like age, gender and family history can lead to an increased risk of stroke, however lifestyle modifications can prevent the likelihood of stroke from occurring. These include:

  • Manage high blood pressure
  • Manage high blood cholesterol
  • Quit smoking
  • Manage weight
  • Eat a healthy diet
  • Exercise regularly
  • Drink alcohol in moderation

Research into stokes 

Sudden Cardiac Arrest

Definition

A sudden cardiac arrest is an electrical problem and occurs when the heart suddenly stops pumping blood. If sudden cardiac death is not treated properly and quickly, it will cause sudden death within 10 minutes.

Symptoms

The symptoms of sudden cardiac arrest are immediate and drastic. They include:

  • Sudden collapse
  • No pulse
  • No breathing
  • Loss of consciousness

Other signs and symptoms may occur before a sudden cardiac arrest, such as fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. However sudden cardiac arrest often occurs with no warning.  

Causes

The immediate cause of sudden cardiac arrest is usually an abnormality in your heart rhythm, known as an arrhythmia.

The most common cause of cardiac arrest is ventricular fibrillation, an arrhythmia where rapid, erratic electrical impulses, cause your heart chambers or ventricles, to quiver uselessly instead of pumping blood.

Deadly arrhythmias do not usually occur on their own. People with normal, healthy hearts may suffer a cardiac arrest due to an outside trigger such as an electrical shock, the use of illegal drugs or trauma to the chest at the wrong time of the heart’s cycle. 

However a cardiac-arrest-inducing arrhythmia usually develops in someone with a pre-existing heart condition. These include:

  • Coronary artery disease
  • Heart attack
  • Enlarged heart (cardiomyopathy)
  • Valvular heart disease
  • Congenital heart disease
  • Electrical problems in the heart

Diagnosis 

Sudden cardiac arrest often occurs with no warning and there is a 90% chance of death if it occurs outside a hospital. If you survive a sudden cardiac arrest, your doctor will want to investigate what caused it to identify the underlying cause. Tests may include:

  • Electrocardiogram
  • Blood tests
  • Imaging tests such as chest x-rays, echocardiogram, nuclear scan
  • Electrical system (electrophysiological) testing and mapping
  • Coronary catheterization (angiogram)
  • Genetic tests

Treatment

Immediate action is required in order to survive a sudden cardiac arrest. The following steps must be taken urgently:

  • Cardiopulmonary resuscitation (CPR) – urgent CPR is critical. By maintaining a flow of oxygen-rich blood to the body’s vital organs, CPR can provide a vital link until more-advanced emergency care is available.
  • Defibrillation – A portable device which momentarily stops the heart and the chaotic rhythm, often allowing the normal heart rhythm to resume. The procedure delivers a therapeutic dose of electric currents to the heart. If a defibrillator is available, it should be used as soon as possible.

Long term treatment includes:

  • Anti-arrhythmic medication
  • Implantable cardioverter defibrillator (ICD)
  • Coronary angioplasty
  • Coronary bypass surgery
  • Radiofrequency catheter ablation
  • Corrective heart surgery

Prevention

There is no definite way to know your absolute risk of sudden cardiac arrest, so reducing your overall risk is the best strategy. This includes regular check-ups at your GP, screening for heart disease and living a healthy lifestyle, for example:

  • Exercise regularly
  • Quit smoking
  • Eat a healthy diet
  • Manage weight
  • Monitor cholesterol levels
  • Monitor blood pressure
  • Manage diabetes
  • Drink alcohol only in moderation

If you have a pre-existing heart condition and are at high risk of a sudden cardiac arrest, you may need the following treatment/s:

  • Anti-arrhythmic drugs
  • Implantable cardioverter-defibrillator (ICD)
  • Purchase an automated external defibrillator (AED)
  • Ensure people around you (family, at work) know CPR

research into sudden cardiac arrest 

Women & Heart Disease

3 times more women die of heart disease than breast cancer in Australia, 50 Australian women have a heart attack every day and 24 women die of heart disease in Australia.

Unfortunately, many women aren't aware of these statistics and heart disease is too often perceived as a common illness among middle-aged men. In fact, the risk of heart problems increases significantly once women reach menopause.

Only one in three women will experience 'typical' heart attack symptoms such as chest pain. Instead, most women suffer from less common warning signs such as:

  • Unexplained nausea
  • Dizziness
  • Weakness
  • Fatigue 
  • Shortness of breath
  • Heart palpitations

The Victor Chang Cardiac Research Institute is committed to raising awareness in the community about women and heart disease, and is dedicated to developing medical research to increase the rate of prevention and improve treatment.

Unfortunately, signs of poor heart health are not always obvious, which is why it's important to regularly monitor things like your cholesterol levels, blood pressure and glucose. It is also important to encourage the women close to you to have regular check-ups to reduce the risk of heart disease or heart attack, which may just be a life saver. 

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