24
sahtak - June 2010
By Yousef Daneshvar, M.D., F.A.C.C.
T
he heart is a crucial part of our body. Since heart
disease is the most common killer inAmerica, it is
important to learn about signs and symptoms of
heart problems in order to treat them before they be-
come untreatable.
1. One of the main symptoms of heart problems is
chest pain or discomfort, better known as Angina. Med-
ically calledAngina Pectoris, this is the sensation a per-
son feels when he/she has blockage of the arteries of
the heart, or coronaries, and which prevents blood and
oxygen from reaching the heart. Importantly, although
this can be felt as pain, many times it is more of a chest
discomfort rather than pain. The chest discomfort from
the heart is located in the middle of the chest rather
than on the left side of the chest and is a deep-seated,
inner feeling. If the coronary blockage is not severe, the
discomfort comes and goes. However, when the block-
age is severe it will cause a heart attack with persistent
chest discomfort unless treated. Many patients with
heart attacks report a heavy weight on the middle of
their chest, such as an elephant sitting on their chest.
Many times they refer to chest pressure and heaviness
in the middle of the chest which prevents comfortable
breathing. At times, they may suspect indigestion and
even try stomach medicine to improve it, but when it is
a heart attack, nothing helps.
Shortness of breath is also a common complaint during
heart attacks. Patients feel as if they cannot breathe easily
or take a full, deep breath. If only they could take a deep
breath they’d feel better, but of course they cannot. The
discomfort from the heart commonly radiates to the left
arm, particularly, to the middle part of the left arm and fin-
gers. It may also radiate to the neck, back and jaws.
If chest discomfort is due to total blockage of the coro-
naries and heart attack, this discomfort will not go away
until treated. However, in partial blockages of the coronar-
ies, chest discomfort will come and go —mostly occur-
ring with activity and exercise. With exercise, the blood
pressure and heart rate increase and increase the need
oxygen,which the limited blood supply will not be able to
provide. The result is chest discomfort. With partial
blockage of the coronaries, the chest discomfort will im-
prove with rest or use of a medicine called nitroglycerin,
which may be placed under a patient's tongue or used in
the form of a spray. Importantly,when a patient takes ni-
troglycerin, they should sit or lie down since this medicine
causes a drop in blood pressure and fainting may occur.
2. Shortness of breath, here referred to as SOB, is a
major and very common symptom of heart problems.
Many times patients with heart problems complain about
getting short of breath with activity.They cannot do as
much because of it. In the beginning, SOB happens with
mild activity such as going up stairs or brisk walking and
carrying heavy objects.However, later it will happen with
even limited activity, at rest or when lying down to sleep.
Shortness of breath is commonly due to weakness of the
heart muscle, a result of which blood is not able to pump
forward, and hence backing up in the lungs. Backing up of
blood in the lungs makes them congested and heavy, not
allowing air to flow easily. SOB also happens with coronary
artery blockages when enough blood does not reach the
heart muscle. This stiffens the heart muscle and prevents it
from functioning normally, leading to lung
congestion. This congestion of the lungs also oc-
curs when the heart valves are abnormal, as in not opening
fully, called "stenosis." Or not closing fully, called "regurgita-
tion or insufficiency."
There are four valves in the heart and their job is to
allow the blood to move only in one direction: forward.
Valve problems,when severe, cause backing up of blood to
the lungs and lung congestion. Many times doctors find
mild heart valve problems with an echocardiography exam
which will not affect the heart’s function and so the patient
does not have to worry about them. Of course, this is an
issue that patients should discuss with their doctors.
3. Palpitations.Many patients with heart problems
complain about rapid heartbeats,which is bothersome.
This may happen at rest or mostly when they go up stairs
or do physical activity. Commonly, the palpitation is due to
problems of the heart, however, it can also be due to other
causes such as drinking too much coffee, dark tea or in-
gesting caffeine in any form. Other causes are thyroid
problems, anemia, anxiety, panic attacks, infection etc.
Therefore, the general rule is that when a patient experi-
ences palpitation, they should be checked by a doctor who
can decide its cause. In this process, doctors commonly
need to diagnose the heart condition, since palpitation in a
diseased heart is very different from that of a healthy one.
A complete exam is needed for accurate decision making.
4. Irregular heartbeat. In this condition, the heart sim-
ply beats irregularly. Examples areAtrial fibrillation and
Atrial flutter,which mostly occur in patients with underly-
ing heart problems such as heart attack, high blood pres-
sure, aged heart, etc. Irregular heartbeats are mostly
chronic conditions in which in addition to irregular beats,
the heart also beats rapidly. Thus,we end up giving medi-
cine to slow the heart down.
With irregular heartbeats, there is also a chance of
blood clot formation in the heart that may travel to the
brain and cause a stroke. This is extremely important to
be prevented.Thus,we prescribe a blood thinner named
Coumadin, orWarfarin, to prevent stroke in these patients.
It is crucial for patients to take this medicine regularly and
have their blood checked periodically. In some patients
with irregular heartbeats,we end up placing a pacemaker
to prevent from their heart from beating too slow. A
pacemaker has a size of about a man’s watch and is placed
under the left shoulder skin area and works for about 8-
10 years before its battery needs to be changed. A pace-
maker is only to prevent too slow heart beats and nothing
more.
5. Extra heart beats. Extra heart beats, or premature
heart beats, are abnormal and come between normal
heart beats. They are like an unwanted, uninvited person
who comes early for dinner when the lady of the house is
busy with her own work. They may initiate from different
heart chambers. Although premature heart beats may
occur in a person with a healthy heart, in general, they are
more common in a diseased heart and their presence
therefore causes us to check the heart thoroughly. They
are of different kinds; some are mild while some are very
dangerous, so again the doctor needs to sort out which is
which. One major issue to note is the condition of the
heart, since premature heartbeats occurring in a healthy
heart would not be as dangerous as those occurring in a
diseased heart. Frequent, extra heartbeats make the prob-
lem even worse and may end up making the heart beat ir-
regularly or fast. Although
some extra heart beats may be
left alone,most of them need to
be treated, and this depends on
their nature, frequency, condi-
tion of the heart and some
other issues. Thus, the doctor
needs to check the heart thor-
oughly and decide.
6. Swelling of the legs.This com-
monly occurs with heart failure,when the
heart does not pump the blood forward for
one reason or another and it backs up into
the lungs, liver and legs. In the lungs, the extra
fluid causes congestion of the lungs and SOB. In the liver, it
causes congestion of and enlargement of the liver. In the
legs, it causes swelling of the legs, due to the presence of
extra fluid in the system. In the daytime when the patient
is standing or sitting, the extra water in the system moves
down to the legs and when the patient lays down, it moves
to the upper body and the lungs, causing congestion and
shortness of breath. Swelling in one leg can be due to a
blood clot in that leg or pressure on the veins or lym-
phatic system in that leg. Swelling of both legs may hap-
pen because of other diseases as well, such as kidney
failure, liver failure, etc. Luckily,we can check the liver, kid-
neys and heart of patients easily and decide what is causing
their problem.
7. Low blood pressure. Patients with significantly weak
hearts commonly also have low blood pressure. There are
multiple reasons for this:
The weak heart cannot pump blood forward and raise
the blood pressure.
Many medications that are used for heart problems,
such as water pills,ACE inhibitors, beta blockers orAldac-
tone bring blood pressure down and patients ends up hav-
ing upper blood pressures in range of 80-90 mm Hg and
even lower.
Patients commonly also have other problems and turn
out to be weak and cachetic as well,which cause lower
blood pressure.
It is important to note that a low blood pressure alone
is not an indicator of heart disease. For example,many
young people—particularly females--have low blood pres-
sure in the range of 85-90 mmHg and sometimes lower. It
is normal for them to thrive and function despite having
low blood pressure.
8. Fatigue, tiredness and lack of energy. These symp-
toms also occur in patients with advanced heart disease
when the heart is weak and not able to pump the blood
to the body. Consequently, the muscles and the whole
body do not get the oxygen and the nutrients they need
for proper function. When the muscles cannot work well
and the system is malnourished, it does not function nor-
mally and leads to feelings of tiredness and fatigue. Impor-
tantly, some medications such as beta blockers (Tenormin,
Lopressor, Inderal, etc.) have their own tendency to induce
feelings of fatigue.
I want to end my writing with the mention of what I
sometimes say at the end of my conferences; that the
heart is only one part of our body — and our body is for
having a life. In order to have a good life we not only need
a good heart and good body, but so many other things as
well. In order to have a good life, I believe we need not
only think about ourselves but to consider the well-being
of others.Thus,we need to be a good person, a fair per-
son, to behave decently, respect others, help them, love
them and forgive others' mistakes as we would want them
to do unto us.
I have to say that following religion in the way it is in-
tended is to be part of our daily life. In my observation,
most people who are religious are nice people with
healthy hearts, anyway.
Signs and symptoms
of heart problems
