Heart Disease -Part II

SYMPTOMS AND CAUSES FOR HEART DISEASE

2.1 SYMPTOMS Heart disease symptoms depend on what type of heart disease you have.Symptoms of heart disease in your blood vessels (atherosclerotic disease) Cardiovascular disease symptoms may be different for men and women. For instance, men are more likely to have chest pain; women are more likely to have other symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue.

Symptoms can include:

• Chest pain, chest tightness, chest pressure and chest discomfort (angina)
• Shortness of breath
• Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed
• Pain in the neck, jaw, throat, upper abdomen or back

You might not be diagnosed with cardiovascular disease until you have a heart attack, angina, stroke or heart failure. It's important to watch for cardiovascular symptoms and discuss concerns with your doctor. Cardiovascular disease can sometimes be found early with regular evaluations.

Heart disease symptoms caused by abnormal heartbeats (heart arrhythmias): A heart arrhythmia is an abnormal heartbeat. Your heart may beat too quickly, too slowly or irregularly. Heart arrhythmia symptoms can include:

• Fluttering in your chest
• Racing heartbeat (tachycardia)
• Slow heartbeat (bradycardia)
• Chest pain or discomfort
• Shortness of breath
• Lightheadedness
• Dizziness
• Fainting (syncope) or near fainting

Heart disease symptoms caused by heart defects : Serious congenital heart defects — defects you're born with — usually become evident soon after birth. Heart defect symptoms in children could include: ? Pale gray or blue skin color (cyanosis) ? Swelling in the legs, abdomen or areas around the eyes ? In an infant, shortness of breath during feedings, leading to poor weight gain

Less serious congenital heart defects are often not diagnosed until later in childhood or during adulthood. Signs and symptoms of congenital heart defects that usually aren't immediately life-threatening include:

• Easily getting short of breath during exercise or activity
• Easily tiring during exercise or activity
• Swelling in the hands, ankles or feet

Heart disease symptoms caused by weak heart muscle (dilated cardiomyopathy) : In early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, symptoms may include:

• Breathlessness with exertion or at rest
• Swelling of the legs, ankles and feet
• Fatigue
• Irregular heartbeats that feel rapid, pounding or fluttering
• Dizziness, lightheadedness and fainting.

Heart disease symptoms caused by heart infections: Endocarditis is an infection that affects the inner membrane that separates the chambers and valves of the heart (endocardium). Heart infection symptoms can include: ? Fever ? Shortness of breath ? Weakness or fatigue ? Swelling in your legs or abdomen ? Changes in your heart rhythm ? Dry or persistent cough ? Skin rashes or unusual spots.

Heart disease symptoms caused by valvular heart disease : The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that open and close to direct blood flow through your heart. Valves may be damaged by a variety of conditions leading to narrowing (stenosis), leaking (regurgitation or insufficiency) or improper closing (prolapse). Depending on which valve isn't working properly, valvular heart disease symptoms generally include: ? Fatigue ? Shortness of breath ? Irregular heartbeat ? Swollen feet or ankles ? Chest pain ? Fainting (syncope)

When to see a doctor: Seek emergency medical care if you have these heart disease symptoms: ? Chest pain ? Shortness of breath ? Fainting Heart disease is easier to treat when detected early, so talk to your doctor about your concerns regarding your heart health. If you're concerned about developing heart disease, talk to your doctor about steps you can take to reduce your heart disease risk. This is especially important if you have a family history of heart disease. If you think you may have heart disease, based on new signs or symptoms you're having, make an appointment to see your doctor.

2.2 CUASES - Causes of heart arrhythmia

Common causes of abnormal heart rhythms (arrhythmias) or conditions that can lead to arrhythmias include:

• Heart defects you're born with (congenital heart defects)
• Coronary artery disease
• High blood pressure
• Diabetes
• Smoking
• Excessive use of alcohol or caffeine
• Drug abuse
• Stress
• Some over-the-counter medications, prescription medications, dietary supplements and herbal remedies
• Valvular heart disease

In a healthy person with a normal, healthy heart, it's unlikely for a fatal arrhythmia to develop without some outside trigger, such as an electrical shock or the use of illegal drugs. That's primarily because a healthy person's heart is free from any abnormal conditions that cause an arrhythmia, such as an area of scarred tissue. However, in a heart that's diseased or deformed, the heart's electrical impulses may not properly start or travel through the heart, making arrhythmias more likely to develop.

Causes of congenital heart defects : Congenital heart defects usually develop while a baby is in the womb. Heart defects can develop as the heart develops, about a month after conception, changing the flow of blood in the heart. Some medical conditions, medications and genes may play a role in causing heart defects. Heart defects can also develop in adults. As you age, your heart's structure can change, causing a heart defect.

Causes of cardiomyopathy : The cause of cardiomyopathy, a thickening or enlarging of the heart muscle, may depend on the type:

• Dilated cardiomyopathy: The cause of this most common type of cardiomyopathy often is unknown. It may be caused by reduced blood flow to the heart (ischemic heart disease) resulting from damage after a heart attack, infections, toxins and certain drugs. It may also be inherited from a parent. It usually enlarges (dilates) the left ventricle.
• Restrictive cardiomyopathy: This least common type of cardiomyopathy, which causes the heart muscle to become rigid and less elastic, can occur for no known reason. Or it may be caused by diseases, such as connective tissue disorders, excessive iron buildup in your body(hemochromatosis), the buildup of abnormal proteins (amyloidosis) or by some cancer treatments.

Causes of heart infection : A heart infection, such as endocarditis, is caused when an irritant, such as a bacterium, virus or chemical, reaches your heart muscle. The most common causes of heart infection include:

• Bacteria
• Viruses
• Parasites

Causes of valvular heart disease : There are many causes of diseases of your heart valves. You may be born with valvular disease, or the valves may be damaged by conditions such as:

• Rheumatic fever
• Infections (infectious endocarditis)
• Connective tissue disorders

Statistics in India

A study shows that heart ailments caused more than 2.1 million deaths in India in 2015 at all ages. Graphic: Mint

New Delhi: Deaths from heart-related disease among rural Indians have surpassed those among urban Indians, according to a forthcoming study in The Lancet. The study, to be published in the August edition, also suggests that unlike in the West, obesity may not be a big driver of such deaths in India. The study, which provides the first-of-its-kind nationally representative estimates of cardiovascular mortality in India, shows that heart ailments caused more than 2.1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30-69 years, of 1.3 million cardiovascular deaths, 0.9 million (68.4%) were caused by coronary heart disease and 0.4 million (28.0%) by stroke. Adults born after the 1970s are much more vulnerable to such deaths than those born earlier, the study shows.

The study is part of the Million Death Study project set up by the Registrar General of India (RGI) in collaboration with global health experts to investigate the causes of deaths in India using nationally representative survey data.

The study shows that deaths due to coronary heart diseases and strokes were more common among the urban population at the turn of the century. But the trend has reversed since then. Between 2000 and 2015, the age-standardized rate of mortality (per 100,000 person years) due to coronary heart diseases increased among rural men by over 40% even as it declined among urban men. For females, the increase was over 56% in rural India. The study focuses on the 30-69 age groups in both rural and urban India since deaths in this age group are likely to be preventable, and the autopsy data for this age group tends to be more accurate. Mortality rates due to strokes declined in both rural and urban areas, but the slide was steeper in urban India (see Chart 1). While coronary heart disease-related deaths have increased in relatively prosperous states such as Tamil Nadu, Karnataka, Punjab and Haryana, stroke-related deaths have increased in the relatively poorer states of the Northeast, West Bengal, and Chhattisgarh. In the high-burden states of the North-East, West Bengal and Chhattisgarh, stroke mortality rates were about three times higher than the national average.

States with high stroke mortality rates had low mortality rates of coronary or ischaemic heart disease and vice-versa, the study shows. A comparison with 2015-16 data on obesity sourced from the National Family Health Survey (NFHS) shows that there is an inverse relation between obesity and stroke-related deaths across states among both men and women (figure 2). The link between body mass index (BMI) and heart-related deaths found in other countries may not apply in the Indian case, the authors of the study argue. “A low BMI might paradoxically predict increased mortality in India for unknown reasons,” the study said. One factor that may explain the twin paradox of higher cardiovascular mortality in rural India and the higher strokerelated mortality in eastern India is access to quality healthcare. Access to doctors and quality hospitals is much lower in rural and poorer parts of the country, where BMI levels also tend to be low. A 2016 WHO report showed that 58% of doctors in urban areas had a medical degree, while only 19% of those in rural areas had such a qualification. Data from the National Rural Health Mission shows that nearly 8% of primary health centres in rural India were functioning without a doctor, while 61% of them had just one doctor as of March 2017. The Lancet study shows that the proportion of those dying of coronary heart disease with a diagnosis of pre-existing heart disease rose between 2001 and 2013. At least half of these individuals were taking no regular medication. In high-burden states, the proportion of stroke deaths with a history of pre-existing stroke also saw an increase, and the majority of these individuals were not on any medication. It is likely that the combination of poverty, ignorance and lack of access to sound medical advice is driving heart disease related deaths in the country. The other big driver could be smoking (figure 3). Although the proportion of smokers has come down between 2005-06 and 2015-16, rural India still has a higher share of smokers than urban India. Quitting smoking can help prevent a significant share of premature deaths, the authors of the Lancet study suggest.