First Steps to a Healthy Heart
Heart disease kills causes almost one in four of all deaths in the United States, and is the leading cause of death in both men and women. In the UK, the figures are similar. But there are things we can do to look after our hearts, and to ensure that we are not one of those who die prematurely. Looking after ourselves not only makes us feel better, it means we live longer. In this comprehensive introduction, GP Simon Atkins looks at the heart, how it works, and what the common malfunctions are, covering the common symptoms, causes, specific investigations, treatment and outlook. This book will help you give your heart the best chance of carrying on beating for many years to come.
1129871874
First Steps to a Healthy Heart
Heart disease kills causes almost one in four of all deaths in the United States, and is the leading cause of death in both men and women. In the UK, the figures are similar. But there are things we can do to look after our hearts, and to ensure that we are not one of those who die prematurely. Looking after ourselves not only makes us feel better, it means we live longer. In this comprehensive introduction, GP Simon Atkins looks at the heart, how it works, and what the common malfunctions are, covering the common symptoms, causes, specific investigations, treatment and outlook. This book will help you give your heart the best chance of carrying on beating for many years to come.
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First Steps to a Healthy Heart

First Steps to a Healthy Heart

by Simon Atkins
First Steps to a Healthy Heart

First Steps to a Healthy Heart

by Simon Atkins

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Overview

Heart disease kills causes almost one in four of all deaths in the United States, and is the leading cause of death in both men and women. In the UK, the figures are similar. But there are things we can do to look after our hearts, and to ensure that we are not one of those who die prematurely. Looking after ourselves not only makes us feel better, it means we live longer. In this comprehensive introduction, GP Simon Atkins looks at the heart, how it works, and what the common malfunctions are, covering the common symptoms, causes, specific investigations, treatment and outlook. This book will help you give your heart the best chance of carrying on beating for many years to come.

Product Details

ISBN-13: 9780745980393
Publisher: Lion Books
Publication date: 09/20/2019
Series: First Steps series
Sold by: Barnes & Noble
Format: eBook
Pages: 112
File size: 1 MB

About the Author

Dr Simon Atkins is a busy GP. He also specializes in covering health issues in the media both on TV and radio and in books, newspapers, and magazines. He is the author of numerous books including of First Steps to living with Dementia and First Steps out of Smoking (Lion Hudson).

Read an Excerpt

CHAPTER 1

How your heart works

I'm writing this chapter in early February and with Valentine's Day fast approaching the shops are currently stocked full of cards and balloons emblazoned with images of hearts. But these love hearts don't even bear a passing resemblance to the actual shape and structure of the fist-sized muscular organ pumping away inside our chest, even when it's love and romance that's making it pump that little bit faster.

In this chapter we will consider what the heart actually looks like, the electrical system that repeatedly fires it into action, and the way in which it supplies its own muscle with the blood that allows it to pump the rest of the blood around our bodies 100,000 times per day.

What does the heart do?

The heart is, in essence, a pump. Its job is to ensure that blood can circulate all around the body so that it can supply our brain, muscles, and other vital organs with the oxygen and nutrients they need to keep working and keep us alive.

All of the oxygen that we need is breathed in through our lungs where it is then absorbed into the bloodstream. The nutrients enter our bodies through our mouths as the food we eat and drinks we swallow, and once the contents of our meals and snacks have been broken down into their constituent proteins, fats, carbohydrates, vitamins, and minerals in our gut they, like the oxygen, are absorbed into our bloodstream where they can then be propelled by our hearts to all corners of our bodies.

In short, if the heart stops pumping, then we stop too.

Where is your heart?

The heart is situated pretty much in the middle of your chest, sandwiched between your left and right lungs. Most of it lies directly behind your breastbone but its apex at the bottom is under your sixth rib on the left-hand side.

A small number of people (thought to be around one in 12,000 of us) are born with the heart the other way around, as a mirror image of its position in everyone else. This is known as dextrocardia, from the Latin word dexter, which means "right". People with dextrocardia don't tend to run into any serious medical problems but they have provided endless opportunities for doctors to fool young medical students, because they can't hear a heartbeat when the usual left-hand side of their chest is listened to and their chest X-rays always look back to front.

The structure of the heart and circulation

The heart is at the centre of a complex system of blood vessels whose job it is to carry the oxygen-rich blood from the lungs throughout the body and back again so the process can be repeated over and over, 24/7, until the moment we die. It's reckoned that each day 23,000 litres of blood are pumped around this system.

Blood flow through the heart

The heart is essentially made up of four chambers: the left and right atria and the left and right ventricles (see Fig. 1 opposite). Blood that has been around the body and been stripped of its oxygen returns to the right atrium in one of two large veins, either the superior or the inferior vena cava. The inferior vena cava also contains the nutrients that have been absorbed from the gut.

From the right atrium, the blood then passes into the right ventricle before being pumped through one of two large blood vessels called the pulmonary arteries back to the lungs where it can pick up a fresh supply of oxygen.

Once oxygenated it passes back to the left atrium of the heart in the pulmonary veins. From the left atrium it then heads into the left ventricle, the heart's main pumping chamber, which then contracts to push it through another large blood vessel called the aorta from where it flows off around the body once more.

Heart valves

In order to stop the blood flowing backwards into the chambers it has already passed through, there are four valves which are designed to shut tight once the chamber has been emptied. These valves sit between the atria and ventricles on each side and between the ventricles and the pulmonary artery and aorta.

These valves are called:

• tricuspid valve (because it has three flaps) – between the right atrium and right ventricle

• pulmonary valve – between the right ventricle and pulmonary artery

• bicuspid valve (because it has two flaps) or mitral valve (because it looks like a bishop's mitre) – between the left atrium and left ventricle

• aortic valve – between the left ventricle and aorta.

The tricuspid and mitral valves are prevented from turning inside out when the heart contracts by the chordae tendineae, which anchor them to the walls of their respective ventricles via small muscles called papillary muscles. These contract to keep the chordae under tension. Often called "heart strings" because of their appearance inside the heart, the chordae tendineae are really more like the guy ropes on a tent, or rigging on a ship's sail.

Blood vessels: the arteries and veins

All blood vessels that leave the heart are called arteries, while those that bring the blood back are all called veins. Arteries have muscular walls which can make the diameter of these vessels wider or narrower and so change the pressure under which the blood is being pumped. This is what we call our blood pressure (more of which in Chapter 8) and it helps make sure the blood reaches the tips of our fingers and toes.

Veins, on the other hand, aren't as muscular and they depend on the squeezing of muscles in our legs to help push blood back towards the heart. They have a number of small, bicuspid, valves inside them to stop blood moving in the wrong direction and going back to where it came from. For example, the femoral vein, which runs the length of the thigh, has around six of these valves.

The arteries and veins in our bodies form an interconnected network of vessels, much like branches on a tree. Blood passes along the equivalent of the tree's main trunk (the aorta) and then into large branches, then smaller ones, and finally into the twigs at the ends of those branches. In our body these vessels are called arteries, arterioles, and capillaries as they decrease in size. The capillaries then pass the blood into small veins (venules), and then on into increasingly larger veins until the blood arrives back at the heart.

How the heart pumps

Much like the pump in a home central heating system or the fuel pump in a car engine, the pump in your chest is sparked into life by our very own electrical ignition system. Thankfully, we don't have to remember to turn a key or flick a switch to get this one going. In fact, it all happens automatically without even involving our brains. Which is perhaps just as well because if we had to think our hearts into action, we might well forget when we were distracted and a heart-stopping moment in a film or TV show might actually do just that.

The pacemaker

The trigger for the heart's electrical activity, which goes on to produce each of our heartbeats, is called the sinoatrial node (SA node). It gets its name because of its position at the top of the right atrium next to what's called the sinus venosus, where the superior vena cava enters the heart.

The SA node was first discovered in the early 1900s by a medical student, Martin Flack, who was studying the heart of a mole. It consists of a dense collection of specialized heart muscle cells that repeatedly generate electrical charge which, they then discharge seventy to eighty times per minute.

The conducting system

Once produced in the SA node the charge quickly spreads through both atria causing the muscles in their walls to contract and pump the blood into the ventricles. Next the electrical impulse reaches the atrioventricular or AV node.

This node, like the SA node, is another collection of specialized muscle cells, situated in the middle of the heart between the atria and ventricles. Its job is to slow down and regulate the electrical signal that has come from the atria to ensure that they have completely emptied their blood into the ventricles and that the heart doesn't beat too fast.

Next the charge passes into a bundle of electrical fibres, called the bundle of His (named after the Swiss doctor, Wilhelm His, who first discovered them in 1893), as it is transmitted from the atria to the ventricles. It then follows one of two pathways, through either the left or right bundle of fibres, to stimulate the left and right ventricles to contract from the bottom up and squeeze their blood on to the next stage of its journey.

Once the ventricles have contracted, the electrical signal in them is reset and their muscles relax and another wave of charge heads out of the SA node to repeat the whole process all over again. And all of this takes place in generally less than a second.

Mythbuster

Heart failure happens when your heart stops beating.

Heart failure is the term used to describe what happens when the heart stops pumping as well as it should. This is most commonly caused by damage to the heart muscle, for example after a heart attack, or because of disease or damage to the heart valves meaning the blood does not flow through the heart and out into the circulatory system as efficiently as it should.

It can also be caused by conditions which slow down the heartbeat, but if the heart stops beating altogether it results in what's called a cardiac arrest, which can be fatal in just a matter of minutes.

CHAPTER 2

Common symptoms

In this chapter we will take a brief look at some of the most common symptoms you might experience that should ring alarm bells that you may have a problem with your heart. They can, of course, be caused by other problems, but any of these should trigger you to make an appointment with your GP to find out what's going on.

The four most frequent symptoms – the headline acts of heart disease – are:

• chest pain

• shortness of breath

• palpitations

• ankle swelling.

Chest pain

As we'll see in much more detail in Chapter 4, chest pain can be caused by a variety of different underlying medical conditions and can have a range of qualities to it, from being a stabbing pain, to feeling as though you've got a rather large elephant sitting down on your breastbone. But however you experience it, and whatever the cause turns out to be, getting regular bouts of severe chest pain is not a good symptom to ignore.

In general, pain related to the heart occurs in the middle of the chest and is frequently brought on by pretty much any type of exertion, from a brisk walk to using your vacuum cleaner.

It can be mild or severe and won't necessarily conform to the medical textbook (or NHS website) description of being a heaviness. In fact, descriptions of pain that has turned out to be due to heart disease include:

• tightness

• fullness

• squeezing

• heavy pressure

• crushing

• like heartburn or indigestion.

So the bottom line here is to seek medical advice if you get any of these types of chest pain, or if you get any others I've not listed that are worrying you. And don't be put off getting in touch because you think you're too young, in good physical shape, you don't like to bother people, or have too busy a lifestyle to make an appointment. I've seen very active, thin, young people have heart attacks and many people who've regretted not seeing a doctor sooner than they did.

Shortness of breath

We've all, no doubt, felt out of breath when we've done a bit more exercise than we're used to, or when we're unfit. It can also be a symptom of a heavy cold, smoking, being overweight, or a panic attack.

But regular breathless episodes with a minimal amount of exertion, or nothing to explain them, need checking out.

Breathlessness related to the heart can be caused by:

• a heart attack

• heart failure

• palpitations

• heart valve disease.

We'll be looking at these in more detail in subsequent chapters but the take-home message for now is that you should certainly see your doctor:

• if it's lasted more than a month

• if it's brought on by minimal exercise

• if you get pain with it

• if you feel your heart racing at the same time and you've not been exercising

• if it happens when you lie down

• if you get ankle swelling with it

• if it worries you for any other reason whatsoever!

Palpitations

Palpitations are the sensation you get when your heart is beating really quickly, fluttering, or beating irregularly. They are not a disease in themselves but a symptom of something potentially abnormal going on with your heart.

Thankfully, they are often harmless and more annoying than serious. And they can be set off by a whole range of different triggers.

Non-cardiac (heart-related) triggers

These can include:

• exercise

• caffeine in coffee and tea

• alcohol

• lack of sleep

• being stressed or anxious

• medication such as asthma inhalers, antidepressants, and some antibiotics (especially erythromycin and clarithromycin)

• hormone changes such as during periods and the menopause and because of an overactive thyroid gland

• anaemia

• fever

• dehydration.

Cardiac causes

These can include:

• electrical problems called arrhythmias (like atrial fibrillation and supraventricular tachycardia)

• valve disease

• muscle abnormalities (cardiomyopathies)

• heart failure.

We'll be looking in more detail at these cardiac causes in later chapters of the book, but they are the reason you need to take palpitations seriously and you should see your GP if they last a long time, they are associated with other symptoms like chest pain, breathlessness or giddiness, or you're simply bothered about why they're happening.

Ankle swelling

As you'll no doubt have guessed, swelling of your ankles and feet doesn't necessarily mean you've got heart trouble, but it can do. So as with the symptoms above, it's worth taking note of.

Once again we can look at the causes in terms of being either cardiac or noncardiac. And as you'll see, many of the non-cardiac causes are in no way even vaguely serious.

Non-cardiac causes

These include:

• standing up too long

• sitting down too long

• a flight on an aeroplane or a long car or coach journey as a passenger

• hot weather

• being overweight

• having varicose veins

• an ankle sprain

• arthritis of the joint, or gout

• liver or kidney disease.

Cardiac causes

• Heart failure.

• Side effects of blood pressure medicines (calcium channel blockers).

We'll be looking at the causes of heart failure in later chapters, but even though it's only one among many other potentially less serious causes, if you have recurrently swollen ankles you should certainly get it checked out, particularly if it's associated with shortness of breath or you're known to already have a type of heart disease.

Mythbuster

Heart disease is a man's problem.

Sorry ladies, but the statistics actually tell us that more women than men die of heart disease each year. In fact, it is the leading cause of death in women, whereas it comes second to cancer in men.

CHAPTER 3

Checking out your heart

If you've experienced any of the symptoms mentioned in the previous chapter, or you're just concerned that some other symptom you've noticed might be heart related, where do you go to find out what's what? And how urgently?

In this chapter we'll look at the available options for having your heart checked so that either your condition can be treated or your mind can be put at rest. But it's important to remember that some of the symptoms in Chapter 2 are not just early warning signals that something's wrong and needs looking into; they can be multi-decibel alarm bells telling you to take action now. So while it may be alright to wait for the next routine appointment at your GP surgery with some symptoms, others are potentially life threatening and warrant picking up the phone and dialling 999 immediately.

My grandpa, a stiff upper-lipped, no nonsense Geordie who had served on HMS Belfast in the Arctic convoys in World War Two, put his crushing central chest pain while driving back to Portsmouth from a holiday in Cornwall down to a touch of indigestion, even though the antacids he took didn't remotely take the edge off his symptoms. He managed to get home and had an early night (and no doubt a medicinal cup of tea) to see if he would feel better the next morning. But when he woke, the pain was as intense as ever and he eventually gave up on the heartburn remedies and took himself to hospital.

Once in the emergency department he was wired up to an ECG machine (more of which later in the chapter) and it very quickly became apparent that he'd been having a massive heart attack while he'd motored up the A303 the day before. He mercifully survived the episode, but having left it so long to seek medical attention, the damage that his heart had sustained over the previous twenty-four hours was sadly permanent.

And he's by no means alone. Many of my own patients have either not quite taken their symptoms as seriously as they should do, stuck their heads in the sand and ignored them, mistaken them for symptoms of something else, or unnecessarily gritted their teeth so as not to bother the doctor.

(Continues…)


Excerpted from "First Steps to a Healthy Heart"
by .
Copyright © 2019 Simon Atkins.
Excerpted by permission of Lion Hudson Limited.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Contents: 

Introduction 7
1 How your heart works 10
2 Common symptoms 17
3 Checking out your heart 23
4 Chest pain 33
5 Trouble with valves 49
6 Electrical problems (arrhythmias) 58
7 When the muscle malfunctions 69
8 High blood pressure (hypertension) 75
9 Looking after your heart 87
10 Living with heart disease 99
Appendix: Further sources of advice
and information 106

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