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Heart disease
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Heart disease
ADRIAN CHENZBRAUN, MD, FRCP, FESC
Consultant Cardiologist
The Royal Liverpool University Hospital
The Liverpool Heart and Chest Hospital
1
1
Great Clarendon Street, Oxford OX2 6DP
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British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloguing in Publication Data
ISBN 978-0-19-9582815
10 9 8 7 6 5 4 3 2 1
Typeset in Plantin
by Glyph International, Bangalore, India
Printed in Great Britain
on acid-free paper by
Ashford Colour Press Ltd,
Gosport, Hampshire
Foreword
It has become rather common practice to open a foreword to a publication of
this ranking, or indeed any on the matter of heart disease, with a reminder to
you, the reader, that more than 300,000 people in the UK have a heart attack
each year and furthermore, that one in four of us will die of heart disease. So
how do I, no less keen than all my health professional friends and colleagues,
in any new way raise the clarion call to a higher level and urge us to seek out
change in what appears to be a society that still remains reluctant to listen to
the best advice?
The fact is that we can all positively individually infl uence our health in so
many ways, from the food we eat and the exercize we take, to the partner-
ships we must build with our clinicians and general practitioners. Being
‘doctored’ should not remove the elements of control for either partner, but
instead bring joint control to the surgery. This joint involvement should thus
begin the process of our return to the ‘art of doctoring’.
Risk factor management is now an essential skill and is, or should be, more
about day-to-day front line care. Advances in that care are with us today and
make it possible for physicians to modify the course of disease in many new
and innovative ways. So while this publication is aimed broadly at the pub-
lic, those physicians and other health professionals interested in the preven-
tion, diagnosis, and treatment of cardiovascular disease will also be reminded
and mindful of the role they so importantly play. For instance, the NICE FH
(Familial Hypercholesterolaemia) Guidelines published in August 2008 in
the UK recommended the screening of family members diagnosed with FH.
The importance of such screening cannot be underemphasized as it allows for
the diagnosis, identifi cation and treatment of those affected and thus their risk
reduction of developing CHD. So there is many a reason for the well-informed
and eager-to-learn patient to take note of the pages herein, so rich in state-
of-the-art resources, clearly defi ned referral sections—all presented in a well
laid out format.
I am sure that this publication will ably help in those endeavours, for Heart
Disease: The Facts offers that perfect practical guide on the rationale for
decision-making in clinical practice between those in primary care and the
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Heart disease · thefacts
patient who has today truly begun to understand the need for their presence—
not as an outsider to discussion and decision—but as one who is present and
thus a benefi tting participant in a new working partnership.
Michael Livingston
Director, InterChol—The International Cholesterol Foundation
vi
Preface
Why this book?
For the last 100 years, we have been witnessing a tremendous increase in the
frequency of diseases of the heart and blood vessels (cardiovascular diseases).
There are many reasons for this, several of which are complex, but they have to
do with profound economic, social, and demographic changes, mainly indus-
trialization, urbanization, low levels of physical activity (sedentarism), and the
increased availability of fat- and calorie-rich food. Around the 1970s, cardio-
vascular mortality began to decrease in the Western world because of improved
health consciousness and better medical care, but nevertheless cardiovascular
diseases still account for about half of all deaths in the developed countries and
25% of deaths in the developing world (compared with only 10% worldwide at
the beginning of the 20th century).
As a result of increased life expectancy and improved early detection, the
number of individuals with either manifest cardiovascular disease, or those at
risk of developing it, is continuously growing. With that comes the need for
available information on this ailment and the ways to fi ght it.
Who should read this book and what will
you fi nd in it?
This book is directed at the public at large, both those with and those without
heart disease. It intends to be a practical guide to help you understand com-
mon cardiac conditions and frequently used medical terms and concepts. The
book opens with a general presentation of the structure and function of the car-
diovascular system, followed by chapters dealing with specifi c cardiac diseases.
The chapters begin with a summary of the key points and include frequently
asked questions that are likely to be of interest to a cardiac patient. These ques-
tions have been compiled by the author using experience accumulated through
20 years of interaction with patients and colleagues both in hospital and in
outpatient clinics. Both the usual concerns and anxieties of a newly diag-
nosed cardiac patient and the more ‘professional’ questions of inquisitive and
‘seasoned’ individuals are addressed. A guide to the main cardiac medications
can be found at the end of the book.
vii
Heart disease · thefacts
Although targeted mainly at cardiac patients, this book will also be useful for
paramedics, specialist nurses, support groups, GPs, and all those involved in
treating heart patients in the community.
How to use this book?
The book begins with the structure and functioning of the heart, followed by
a description of specifi c cardiac conditions, and ends with a presentation of
commonly used cardiovascular drugs and devices. However, it does not have to
be read ‘cover to cover’. To facilitate this approach, reference is made when the
same issue is discussed in more than one chapter. Plain language and lay terms
are used throughout the book, but medical terms are mentioned as well, when
appropriate, and a glossary is provided.
viii
Contents
Symbols and abbreviations xi
Section 1
The facts about heart disease
1 How does the cardiovascular system work? 2
2 What are the symptoms of heart disease? 9
3 Cardiac tests 14
4 Risk factors that increase the possibility of heart disease 32
5 Atherosclerosis (Obstruction of the arteries) 48
Section 2
Types of heart disease and other problems
6 Coronary artery disease (ischaemic heart disease) 52
7 Rhythm disturbances (Arrhythmia) 69
8 Congestive heart failure 79
9 Congenital heart diseases 83
10 Cardiomyopathies and arrhythmogenic syndromes 87
11 Pericarditis and myocarditis 92
12 Valvular heart disease 93
13 Sudden cardiac death 99
ix
