PLEASE, ONE OF THE FIRST FACTS THAT WE LEARN IN childhood about the human body is that our life depends on the work of the heart: as long as it beats, we exist. Unfortunately, heart problems may not be so obvious (sometimes we are not aware of them), but they can overtake everyone (even at an early age ), often with irreversible consequences. According to the WHO , in 2015 the most common cause of death in the world was coronary heart disease (almost 9 million cases), and it has been at the top of this list for many years. On the eve of World Heart Day , which is celebrated on September 29, we talked with Leah Ghukasyan, a cardiologist at the LRC of the Ministry of Defense of the Russian Federation, about how to understand that the heart is not in order, what examinations will help to find an ailment, and why you should not rely on energy drinks.
How does your heart ache?
Heart disease is the first thing that comes to mind as soon as pain appears on the left side of the chest. It may indeed indicate a problem, but not all unpleasant sensations in this area indicate a malfunctioning heart – which, by the way, is located not on the left, but in the center of the chest. So, if, when inhaling or exhaling, it sharply stabs in the chest, we can talk, for example, about intercostal neuralgia – pain caused by compression of one of the intercostal nerves. This happens with a sharp muscle spasm, especially in an unusual position – for example, when you looked up unsuccessfully while tying your shoelaces. Such pain most often calms down on inhalation or exhalation, and can disappear after stretching or moving the shoulders.
Since the lungs are located near the heart, many processes associated with them can also respond to chest pain. It is not so difficult to understand what is going on here, because other symptoms of the disease will also be connected – cough, high fever, shortness of breath. But with panic attacks, when, however, there are also difficulties with breathing, it is much more difficult to independently distinguish anxiety from a heart attack – their symptoms often coincide . However, with panic attacks, the pain does not arise in the heart itself, as it may seem to an inexperienced person, but, for example, in the pectoral muscles spasmodic due to stress. Seek urgent medical attention in any case: a heart attack can be fatal, and panic attacks signal a serious psychological imbalance.
But a typical pain, indicating problems with the heart, is a burning, pressing pain behind the sternum, which does not change, no matter how you try to slow down or speed up your breathing or stretch your muscles. In the chest there is a feeling of load, as if a brick is pressing from above, or it seems that it burns and squeezes from the inside. Sometimes the pain radiates – “gives” to another area: under the scapula, in the shoulder, in the stomach or even fingers. This pain is called angina pectoris and requires a mandatory visit to a doctor – it occurs when the load on the heart is too high.
Unfortunately, when atherosclerosis disrupts the normal blood supply to the heart, ischemic disease occurs (ischemia is a lack of “nutrition” of the organ) – in this case, at first, the load may be excessive for the heart during sports, but gradually it will become difficult for it to work at rest. An attack of angina pectoris can develop into a myocardial infarction – when a site of necrosis occurs in the heart muscle due to prolonged ischemia. It is deadly, so a burning or pressing pain behind the sternum is a reason to see a doctor without delay.
Can the heart “freeze”?
Another common heart problem is arrhythmia, that is, a violation of the rhythm. In general, the uniqueness of the heart is that it has a so-called pacemaker – a group of cells that form the impulse of the heartbeat . For its work, even signals from the nervous system are not needed – an isolated heart muscle in laboratory conditions will continue to contract by itself. But for various reasons, interruptions may occur in the work of the heart – the problem may lie in the pacemaker itself or in the areas through which the impulse is transmitted further. Tachycardia and bradycardia (too fast or slow heartbeat) are also considered arrhythmias. With arrhythmia, a person sometimes feels that the heart “freezes”, feels like gaps in the heartbeat, or simply realizes the heartbeat. It also happens that there is arrhythmia, but the person does not feel anything.
There are many types of arrhythmias, and only an examination will help determine the real danger. Arrhythmia may not speak of abnormalities in the body – from time to time any healthy person can encounter it, depending on the circumstances, and respiratory arrhythmia in children, according to Liya Ghukasyan, is a normal age-related feature. Arrhythmia can be a symptom of various diseases , such as myocarditis (inflammation of the heart muscle), thyroid disorders, or the same panic attacks. Acute arrhythmias, including those incompatible with life, can develop , for example, when a heated body is suddenly immersed in cold water.
Unfortunately, arrhythmia cannot always be recorded on a conventional electrocardiogram – for example, if it occurs only during stress, walking or during sleep. In such cases , a Holter examination is prescribed – a person walks with sensors and a device for recording an ECG for a day or two, and then comes back to the doctor. It sounds complicated, but such an examination can be done in a regular clinic. Whether arrhythmia ever develops at all depends on many factors, including hereditary predisposition, current and past heart problems, and lifestyle. Even energy drinks can provoke arrhythmias, so it is worth considering whether such doping is really necessary, especially in large quantities.
Should you be afraid of heart problems?
Although not every heart problem is fatal, ignoring the symptoms is dangerous – coronary artery disease, if left untreated, is more likely to lead to myocardial infarction. As cardiologist Aleksey Utin writes in his blog, without treatment, myocardial infarction will lead to the death of almost a third of patients – and the younger the age, the higher the risk. If myocardial infarction has already developed, then it is extremely important to start treatment urgently, in the very first hours and even minutes. And, of course, it is better to prevent than to cure – coronary heart disease requires constant lifestyle work and regular medication, but it can be life-saving. A postponed myocardial infarction always leaves consequences – there literally remains a scar on the heart, which prevents it from contracting normally. So, statements like “my grandfather had three heart attacks” should not be misleading – you can really survive them if you are lucky, but a healthy heart will be a thing of the past.
For other heart disorders, the same rule applies: prevention is always better than cure. Even heart defects are quite compatible with life, although this also depends on the specific type. A defect is a change in the anatomical structure of an organ; the abnormal structure can be in the valves or septa between parts of the heart, as well as in large vessels. Congenital defects, as the term itself implies, are those with which a child is born, and acquired defects can appear as a result of rheumatism, syphilis, coronary heart disease or various tumors. In any case, the main function of the heart is under threat – it ceases to adequately supply oxygen to other organs and tissues, “oxygen hunger” and heart failure develop. In severe cases, only an operation will help to preserve and prolong life, and lighter heart defects only impose certain restrictions – for example, they require frequent supervision of a cardiologist and refusal from professional sports.
How to watch your heart and not harm it?
Caring for your heart involves attention to your health in general – it is especially sensitive to bad habits and suffers from them in the first place. It is worth thinking about the heart early, not counting that its diseases are “senile” – according to some sources , cholesterol plaques begin to grow in adolescence. It is these plaques that cause atherosclerosis – a narrowing of the patency of the arteries, and if we are talking about the coronary arteries that feed the heart itself, then a lack of blood supply will lead to coronary artery disease.
Heredity is also important – according to Liya Ghukasyan, in order to understand what you may have to deal with, it is a good idea to draw up a family tree of diseases (it is useful not only for heart problems). It can help prevent things that are not always seen in medical research. For example, long QT syndrome, which can cause sudden death at a young age, is inherited and occurs in boys. If there were such cases in the family of one of the partners, it is worth considering a thorough examination of the heart of the sons. Very similar congenital anomaly – syndrome, Brugada , which threatens to sudden deaths; if you know about the presence of this syndrome, its consequences can be successfully prevented.
It is worth examining the heart, if there are no complaints, once a year. As a rule, an examination, a conversation with a doctor and a regular ECG are enough – it will not cover all the problems, but it will accurately inform about the important. If the doctor realizes that it is not enough, he will prescribe an echocardiography (ultrasound examination of the heart). Without special need, “just in case”, it makes no sense to undergo echocardiography annually. It is also worthwhile to periodically donate blood for analysis for the lipid spectrum, that is, different types of cholesterol. If the indicators are higher than normal, it is necessary to correct them – with a diet or special drugs. Even if everything is in order, you do not need to get carried away with animal fats, as they increase the risk of atherosclerosis. The diet for atherosclerosis that has already arisen is quite strict – it is easier and better to adhere to a balanced diet in advance.
Moderate physical activity will help keep the heart in good shape, but professional sports will exhaust this organ rather than strengthen it. Unfortunately, even among young athletes, there are deaths due to sudden cardiac arrest – this is associated with the load on the heart, which can become excessive if its diseases are not diagnosed in time; of course, experiments with prohibited doping agents play a role in such cases. Both cardio training and strength training are useful and recommended, including for heart health, but it is important to observe the so-called target heart rate interval : for a 30-year-old person, this is 95-162 beats per minute. Nowadays, monitoring your heart rate is much easier than it used to be – fitness trackers do it . The new Apple Watch , for example, also notifies the wearer of heart rhythm irregularities and warns of potential problems.