The heart and cardiovascular system:

A fist-sized muscular organ sitting in the middle of the chest cavity, the heart pumps blood through the vast circuit of vessels connecting it to every organ of the body to deliver oxygen and vital nutrients, to remove carbon dioxide and metabolic waste products, and to distribute hormones and messengers throughout the body’s tissues.  The internal conducting system of the heart provides for coordinated muscle contraction of the different chambers (atria and ventricles), and the valves ensure that blood flows only one way (away from the heart in the arteries and toward the heart in the veins).  The coronary arteries supply the oxygen and nutrient demands of the active heart muscle, which efficiently extracts most of the oxygen from the blood delivered to it.

Disease of any part of the cardiovascular system may not only have a local effect, but may also affect other parts of the body.  Due to the diffuse nature of the nerves supplying the internal body organs, symptoms of heart disease may be absent, not well-localized, or similar to that of other conditions.  Risk factors for coronary heart disease include high blood pressure, diabetes mellitus, smoking, family history, and high blood cholesterol level.  Common symptoms for evaluation include new chest discomfort or shortness of breath, especially on exertion, dizziness and blackout spells. 

Symptoms of Heart Disease:

How does one know that he has heart problems or that his symptoms are due to the heart? Sometimes there may be heart trouble with no symptoms and sometimes the symptoms may reflect another problem. However, generally, recurrent or persistent discomfort or pain in the chest or shortness of breath especially of recent onset or occurring with less than usual exertion deserve prompt evaluation. Palpitations, dizziness, and blue or black out spells also may indicate a heart condition.

Procedures to evaluate the heart:

Besides a full discussion with the doctor regarding the patient’s symptoms (history), a careful  physical examination by the doctor can reveal evidence for different types of cardiovascular disease (including: heart murmurs reflecting valvular disease, abnormal heart sounds and evidence of heart enlargement or damage, bruits reflecting arterial disease, blood pressure, retinal arteries, venous pressure and venous return). 

Tests commonly used to evaluate the heart function include the electrocardiogram (EKG or ECG), echocardiograpy and doppler, stress testing (including stress-EKG, stress echocardiography, and nuclear stress testing).  Newer tests including cardiac CT and MRI may be indicated in certain cases. Occasionally it may be necessary to perform more invasive testing of the heart including cardiac catheterization and coronary angiography. 

Treatment of heart disease:

Therapy depends on the specific illness present.  Risk factor modification generally includes diets and smoking cessation.  Medications often are very effective in treatment of hypertension and diabetes, with monitoring to avoid or treat potential side-effects. 

In case of suspected heart attack, time is of the essence.  Immediate treatment of a heart attack includes aspirin and blood thinners (thrombolytics) initiated immediated by paramedics or in the emergency department with consideration of rapid referral to a cardiologist for (acute) angioplasty or coronary stenting when possible.  Severe coronary disease may require coronary artery bypass surgery.  The treatment of heart failure has advanced with new medications.  New devices available include pacemakers, implantable defibrillators, and pumps/ ventricular assist devices.  As always, prevention is preferred.