MATTERS OF THE HEART

She has a big heart.

I am broken—hearted.

I know it in my heart of hearts.

Have a heart.

You’re in my heart.

My heart breaks for you.

The heart is the organ most commonly used in expressions of emotion in our language.   Without being consciously aware, we speak of the human heart in so many ways, most of them referring to how we feel emotionally.  Physically, however, it is one of the most vital organs in our body.  We literally are nothing without its constant beat, its unfailing mission to keep blood pumping throughout our bodies.  Except when it does fail…

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Heart disease is one of the leading killers of men and ranks as the leading cause for women.  There are many diagnoses that define poor heart health, and many causes for these diagnoses.   Heart Failure is a general term used to describe several diagnoses, and does not mean the heart has stopped working completely.  Rather, it refers to a heart condition that causes the heart function to be compromised, and not work as well as it was designed to do.

As one of the miracles of modern medicine, thankfully, there are many procedures, treatments and surgeries that can improve heart health, which in turn can drastically improve the general health of the human body it keeps alive.  This article will explore all aspects:   symptoms, diagnoses and treatments.

Just as matters of the heart in emotional terms vary differently between men and women, so too do they differ physically.  Those differences will be highlighted as well.

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A healthy heart works like this:  the pumping action of the heart moves oxygen-rich blood as it travels from the lungs to the left atrium, then the left ventricle, which, in turn, pumps it through the rest of the body.  This left ventricle supplies most of the heart’s pumping power, which accounts for its larger size relative to the heart’s other chambers.  In left-sided heart failure, the heart must work harder to pump the same essential amount of blood to the body.   This failure may occur in either of the two phases:  systolic, whereby the ventricle loses its ability to contract normally.  In diastolic failure, the ventricle cannot relax normally due to stiffened muscles, therefore preventing the heart from filling properly with blood during the short rest period between beats.

In a healthy heart on the right side, the pumping action moved “used” blood that is returned to the heart through the veins via the right atrium, then on to the right ventricle, which, in turn, pumps the blood back out of the heart into the lungs to be replenished with oxygen.  When the right side of the heart fails, it is typically a by-product of left-sided failure, because the right side must compensate for left weakness.  The right side then loses its pumping power, backing blood up in the body’s veins.  This swelling or edema is most common in the ankles and legs, but can affect other body parts too.

A general term, congestive heart failure (CHF) refers to increased backup or congestion of blood in the bodily tissues, typically, again in the ankles and legs, but it can occur in other body parts too.  It may collect in the lungs and cause difficulty breathing and shortness of breath, and general respiratory distress.  CHF requires timely medical attention.

Heart failure may also affect the kidney’s ability to rid themselves of sodium and water, thus retaining water in the body’s tissues.

Most every adult has heard the advice:  eat healthy foods, get plenty of exercise, keep weight within normal limits, reduce stress, keep cholesterol levels in check, don’t smoke or quit if you do smoke, get regular checkups, be aware of family history and get plenty of sleep.  These are all great words of advice, and should be followed as closely as possible for everyone.  Even in those who follow these rules faithfully, there still exists a risk for heart failure or heart attack.  Family history, as mentioned above, is a risk factor that must be considered.

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The following symptoms, possibly alone or in any combinations, depending upon the severity, may indicate heart failure and should prompt medical attention:

  • shortness of breath
  • persistent coughing or wheezing
  • buildup of excess fluid in body tissues (edema)
  • unusual fatigue
  • lack of appetite or nausea
  • impaired thinking
  • increased heart rate

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If any of these following symptoms are experienced, you should seek immediate medical attention, calling 911 if necessary, as seconds may count:

*discomfort in the center of the chest that lasts longer than a few minutes, or goes away and comes back, including:  uncomfortable pressure, squeezing, fullness or stabbing pain, HOWEVER:

NOT ALL HEART ATTACKS ARE PRECEDED BY CHEST PAIN

Other symptoms include:

  • chest discomfort
  • discomfort in other upper body areas including one or both arms, the back, the neck, the jaw or stomach
  • shortness of breath with or without chest discomfort
  • pounding heart or changes in heart rhythm
  • heartburn, nausea, abdominal pain, vomiting
  • breaking out in a cold sweat
  • dizziness or lightheadedness

For women, the symptoms are likely to include:

chest pain, but women are more likely to experience shortness of breath, nausea/vomiting and back or jaw pain than men

uncomfortable pressure, squeezing, fullness or pain in center of chest, lasting more than a few minutes, possibly going away and coming back

Again, these symptoms should receive IMMEDIATE medical attention, as seconds do count—your life or the future of your heart may depend on it.  Heart attacks do not always present as they do in the movies, as a dramatic, one-moment occurrence.  Rather; they may come on slowly and last a bit longer that that one dramatic second on television or the movies.

Research has shown that women are more likely to attribute any or all of these symptoms to acid reflux, the flu, normal aging and “normal” fatigue.

Most women think the signs are unmistakable, but in reality, they may be far less extreme than for men.  Many women are shocked to learn they have had a heart attack when they have been diagnosed.   As most women are a caregiver in some form—children, parents—they typically deny their needs and put others needs first, failing to acknowledge the severity of their symptoms.

Depending upon the diagnosis, there are multiple surgeries and procedures that may be performed to improve heart health, including:

Angioplasty:  tubing with an attached deflated balloon is threaded up to the coronary arteries.  The balloon is then inflated to widen blocked areas.  This surgery is minimally invasive, and generally requires an overnight hospital stay.  The surgery lasts about 30 minutes, and greatly reduces the risk for future heart attacks, allows higher levels of physical activity, and decreases chest pain (angina).

Artificial heart valve surgery:  replaces a diseased heart valve with a healthy one to improve valve function.

Bypass surgery:    Also known as Coronary Artery Bypass Graft, or CABG or “cabbage”, this surgery involves grafting veins from other parts of the body to bypass the diseased or clogged arteries to allow better blood flow through the heart, and to avoid the blocked areas.   This is considered major surgery, and typically requires at least 3 days in the hospital.   This surgery improves blood flow throughout the body, reduces risk for further heart attacks, decreases chest pain, and increases capacity for physical activity.  Minimally invasive heart surgery is similar to this surgery, but small incisions are cut into the chest with ports placed to insert small veins from the leg or chest arteries to be attached to the heart to bypass the affected area.  It is much less invasive than bypass surgery.

Cardiomyoplasty:  This experimental surgery takes muscles from the patient’s back or abdomen and “wraps” it around the heart to improve the pumping function of the heart.  It is aided by a device similar to a pacemaker to stimulate contractions.  Its primary purpose is to increase the pumping motion of the heart.

Heart transplant:  removes a diseased or malfunctioning heart from the patient, replacing it with a donor heart.  It is generally recognized as a successful procedure to restore heart health in appropriate patients.

Stent procedure:  A stent is a wire mesh tube used to prop open the artery during angioplasty.  The stent stays in the artery permanently, holding the artery open, improving blood flow to the heart, and improving chest pain.

Radiofrequency ablation/catheter ablation:  A catheter with an electrode at its tip is guided through the veins to the heart muscle, taking a real-time x-ray that is displayed on a large screen.  The catheter is placed at the exact site inside the heart where the cells that are creating the irregular beat give off their electrical signals.  A mild, painless radio frequency (similar to a microwave) is delivered to a small area, carefully destroying the problematic cells.  This is the preferred treatment for many types of rapid heartbeats, as it replaces the erroneous signals with more even, better timed signal.

Pacemaker:  a battery powered device that generates a regular electrical signal to stimulate the pumping activity of the heart is implanted just under the skin, with wires attached to it and to the heart.  It is used  with certain conditions that affect the rhythm of the heartbeat. 

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Heart failure occurs in adults most commonly due to poor lifestyle choices such as smoking, inactivity and poor diet, as well as conditions such as high blood pressure, diabetes, coronary artery disease and bad heart valves.  Sadly, heart failure can also occur in children and babies, although for other reasons.  Structural defects that are often diagnosed within days of birth—approximately 1% of babies are diagnosed and treated, viral infections as well as birth trauma can cause heart defects in newborns.

With adolescents, viral infections can damage the heart, as can certain strong drugs that are typically prescribed to treat cancers.  The heart’s electrical system can be damaged since birth, and may have gone undetected.  Children with muscular dystrophy may experience heart failure, as the heart may become an inefficient pump as the disease progresses.

Earlier today, November 18th, 2015, Doug Flutie, a famous NFL player from the 1980’s, made a public announcement regarding his family.   This morning, his father, who had been struggling with heart disease, died of heart failure.  One hour later, his mother, who had been married to his father for 56 years, also died of a heart attack, unexpectedly. 

“They say you can die of a broken heart,” he said. “I believe it.”

Despite all the medical advancements, the complex and sophisticated treatments and surgeries and extensive research, the human heart will, as the above story illustrates, always remain somewhat of a mystery.

For Doug Flutie, his family, and anyone else who has ever lost a loved one to heart failure, my heart breaks for you.