Heart Disease

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Heart disease is a term used to define a number of serious conditions affecting the heart, often caused by an unhealthy diet. These conditions range from the very common coronary heart disease, (caused largely by lifestyle) to less common cases of congenital heart disease (which manifests before birth).

The following information will guide you through a number of different types of heart disease. From stating vital statistics and symptoms to exploring treatments and preventive measures, this guide aims to help you develop a greater understanding of the biggest killer in the UK.

Types of Heart Disease

The heart is a complex organ consisting of three layers:

1. An outer lining called the 'pericardium’
2. A thick muscular wall made of specialist cells called ‘myocardium’
3. A delicate inner lining called the endocardium

And four separate chambers:

• Two upper chambers called the ‘atria’
• Two lower chambers called the ‘ventricles’

Inside and around the heart there is a complex system of valves, arteries, capillaries and veins that work together to pump blood to the rest of the body.

In order to understand the large number of possible problems that can occur within the heart, it can be helpful to compare it with four components of a house.

• Firstly a house’s plumbing represents the blood supply leading to and away from the heart.  When the arterial walls become clogged with fatty deposits, the blood cannot reach the heart and this causes angina (chest pains). Angina is a symptom of coronary heart disease, the most prevalent of heart diseases.

• Secondly, the bricks and mortar of a house equate to the substance of the heart itself: the muscle. When there are problems with the muscle, the heartbeat can become irregular. This is known as cardiac arethmates, a term that covers conditions including atrial fibrillation and ventricular tachycardia.

• Thirdly the structural components of a house represent the heart’s walls. Valvular disease occurs when the walls of the heart are damaged or leaking.

• Finally, the wiring and electrics within a house represent the actual functioning of the heart. Heart failure is the equivalent of a power-cut.   

10 Facts about Heart Disease^1,2

1. A recent study examined how much the decline in heart disease mortality in England and Wales could be attributed to medical treatment, and how much it could be attributed to risk reductions. Results showed that 58% of the mortality reductions were down to lifestyle changes such as cutting down on smoking, as opposed to medication and treatment.

2. Heart disease is the biggest killer in the UK^.

3. 1 out of every 5 men are expected to die from heart disease this year.

4. 1 out of every 7 women are expected to die from heart disease this year, suggesting that men are more likely to die from heart conditions that women.

5. There are currently 2.6 million people living with heart disease in the UK.

6. Coronary heart disease is the most prevalent of all heart conditions in the UK.

7. Coronary heart disease claims almost 50,000 premature deaths in the UK in a year.

8. 88,000 people die from heart disease in the UK every year.

9. People living in Scotland and northern England are statistically more likely to die from heart disease than those living in the south of England (BHF).

10. Chances of getting heart disease increase with age.

What is Coronary Heart Disease?

Coronary heart disease is the most common type of heart disease. It occurs when the coronary arterial walls become clogged up with fatty deposits, known as atheroma. This blockage narrows the arteries and restricts blood flow to the heart, a process known as athrosclerosis.

Symptoms  of Coronary Heart Disease

Angina

This is the most common symptom of coronary heart disease. It is experienced by 10-15% of women over 65 and by 10-20% of men over 65 years old. Angina is known as a syndrome. By definition a syndrome is a cluster of symptoms indicative of an underlying cause (that cause being coronary heart disease). 

Sufferers of angina will usually experience:

• nausea
• tiredness
• dizziness
• burping
• a feeling of restlessness
• a tight, dull or heavy pain in the chest that can spread to the left arm, neck, jaw and back.

There are two types of angina. Both are suggestive of bad health but one is deemed more serious than the other:  

Stable Angina

This is the less serious of the two types.Stable angina occurs gradually over time and can follow a set pattern. Usually it occurs for a few minutes during exercise or during periods of stress. This is because the heart is beating faster and requires blood to be pumped quicker. Because arteries are clogged with fatty deposits, the required amount of blood cannot be pumped to or away from the heart quickly enough.

By itself,  stable angina is not life threatening, however it is indicative of future more serious heart conditions such as a heart attack or stroke. Sufferers of angina are usually advised to take a drug called glyceryl trinitrate.  

Unstable Angina

 This is the more serious of the two types and should be handled as a medical emergency. In cases of unstable angina, the fatty deposits (known as plaque) rupture and interfere with the normal blood-flow and can cause clotting, which often leads to a heart attack. 

Symptoms usually last far longer (up to 30 minutes) and can develop quickly even during periods of rest. The drug used to alleviate stable angina, glyceryl trinitrate, will often have no effect during a case of unstable angina.

Causes of Coronary Heart Disease

Many causes of coronary heart disease can be reducible by making a number of lifestyle changes. Causes include:

• diabetes
• high blood pressure
• high cholesterol
• smoking
• being overweight or obese
• excessive alcohol consumption.

Some risk factors are predetermined and cannot be changed. These include:

• age
• ethnic background
• family history.

Preventing Coronary Heart Disease

Stop Smoking

Approximately 25% of the UK population smokes and as a result, smoking is one of the most common causes of death. One way smoking can cause death is through coronary heart disease.

• Smoking can damage arterial linings, making it easier for fatty deposits to cling to the walls and form blockages.

• The nicotine found in cigarettes acts as a stimulant, raising heart-rate and blood pressure. This results in the heart having to work harder to pump blood.

• Carbon monoxide released from cigarette smoke reduces the amount of oxygen in the blood, resulting in the heart having to yet again work harder to pump oxygen to the rest of the body.

Healthy Diet

Certain foods contain dietary cholesterol. Cholesterol is essentially fat, so when there is a high amount in the bloodstream it will stick to arterial linings and form blockages.  Foods to avoid include:

• Unsaturated fats e.g. fatty cuts of meat, pastry, chocolate confectionary, biscuits, crisps and other savoury snacks, pies and processed foods (ready meals).

Replacing saturated fat products with unsaturated should help to lower cholesterol:

• oily fish (mackerel and salmon)
• nuts (cashews, almonds)
• vegetable oils (olive, walnut, sesame seed, sunflower)
• seeds (pumpkin and sunflower). 

Exercise Regularly

The benefits of exercise are boundless. Cardiovascular exercise will help burn calories and get rid of excess fat, reducing the risk of cholesterol blockages in the arteries and preventing heart disease. Just 150 minutes of moderate to intensive exercise a week will help improve your cholesterol levels. This could include:

• cycling- puts very little strain on joints
• brisk walking- can burn a lot of calories without exerting the heart too much
• swimming- like cycling, impact on joints is minimal due to the uplift of the water
• yoga- helps build core muscles without adding extra resistance (weight training), which could potentially put strain on the heart.

Reduce Stress

Although not proven to be a direct cause of coronary heart disease, stress can contribute to symptoms in the long-term.

Many people turn to smoking, eating unhealthily and drinking heavily during particularly stressful periods. All three of these risk factors can induce coronary heart disease. So how can stress be reduced?

• Regular activity and cardiovascular exercise will help to combat stress because it releases endorphins (‘feel-good’ hormones).
• Talking to family and friends and taking steps to find support will help alleviate some of the pressure.
• Some people find that meditation or breathing exercises can help them relieve the physical symptoms of stress such as headaches or a pounding heart.
• Talk to a counsellor who can help you deal with your problems from an objective perspective.

Living with Coronary Heart Disease

Coronary heart disease cannot be completely cured. There are however a number of treatments aimed to improve quality of life and reduce symptoms. These include:

• Tackling risk factors: giving up smoking, reducing alcohol consumption, eating healthily, and exercising regularly. 
• Rapid diagnosis: the sooner a GP identifies coronary heart disease, the sooner actions can be taken to prevent heart attack or deterioration.
• Quick treatment during heart attack: it is important for angioplasty treatment to be available once the patient has arrived at hospital. Angioplast is the term used when the blocked artery causing the heart attack is mechanically unclogged.

Medication for Coronary Heart Disease

The medicines used to treat coronary heart disease usually have varying side effects. It is advisable to discuss your options with a GP because different people can react in different ways. Available drugs include: 

ACE Inhibitors (angiotensin converting enzyme)

ACE inhibitors are medicines designed to lower blood pressure, treat heart failure and help protect the kidneys (especially in the case of diabetes).

How do ACE inhibitors work?

The kidneys can detect when blood pressure drops in the body. When this happens, a chemical is released from the kidneys called angiotensin. When the angiotensin reaches the blood-supply and combines with the angiotensin-converting enzyme, the two substances become angiotensin II. Angiotensin II raises the dropped blood pressure by:

1) Narrowing the blood vessels. When the same amount of blood passes through less space, the pressure increases.

2) Releasing another hormone called aldosterone. Aldosterone instructs the body to retain water (which may otherwise pass through as urine). The extra water remains in the blood stream and thus increases the volume of blood running through the body. As with narrowing the blood vessels, more blood in less space increases the pressure in the body.

The medication ‘ACE inhibitors’ blocks angiotensin before it can combine with the angiotensin-converting enzyme. The ACE inhibitor prevents the angiotensin from becoming angiotensin II, meaning that the blood vessels will not narrow and the volume of blood will not increase, thus lowering the blood pressure.

How are ACE inhibitors taken?

ACE inhibitors are taken in the form of a tablet usually once a day, or as the GP advises. ACE inhibitors can often be taken with other heart and blood pressure medications.

What are the side effects of ACE inhibitors?

The most common side effect of taking ACE inhibitors is a dry cough. Patients may also feel dizzy when standing up. This is because the drug lowers blood pressure. Other less common side effects include:

• a rash on the skin
• swelling of the sinuses (called sinusitis)
• a sick feeling or actual vomiting
• problems with bowels- diarrhoea or constipation
• sore throat
• indigestion
• hay fever-like symptoms such as a runny nose, itchy eyes and sneezing.

1 in 10 people have kidney problems as a result of taking ACE inhibitors.

Calcium channel blockers

Calcium channel blockers are designed to lower blood pressure and alleviate the symptoms of angina (chest pains) by working on the muscle cells of the heart and arteries.

How do calcium channel blockers work?

Calcium blockers work in two different ways.

2. By targeting the heart: the heart functions via a series of electrical impulses passed from cell to cell. These impulses are then converted into chemical reactions inside the heart. Each signal carries different information and instructions. One signal carries information about calcium levels within the muscle cells and it is this signal that controls the contraction of the heart muscle. Calcium blockers restrict the flow of calcium into the heart muscle, thus lowering the amount of times the heart contracts.

3. By targeting blood vessels:  the calcium within the muscle cell controls the contraction of the muscle. The calcium channel blocker works by relaxing the walls of the blood vessels and widening the space through which the blood runs, thus alleviating the pressure. 

How are calcium channel blockers taken?

Calcium channel blockers are only available on prescription from your GP. They tend to come as tablets or capsules and should be taken once or twice a day.

It is inadvisable to suddenly cease taking calcium channel blockers, as this can increase the symptoms of angina.

Different brands of calcium channel blockers can release at different paces so only one type should be taken at a time.

What are the side effects of calcium channel blockers?

Calcium channel blockers lower blood pressure and can therefore cause dizziness when moving from a sitting to standing position. It is advisable to stand up slowly next to a stable surface for extra support.

Calcium channel blockers can also slow the heart. This can cause:

• headaches
• fluid retention
• facial flushing
• constipation.

Always read the leaflet accompanying your medication

Thiazide diuretics

There are a number of different types of diuretics. Diuretics (otherwise known as ‘water tablets’) work to reduce the water content within the body by instructing the kidneys to produce more urine.

Thiazide diuretics are the most commonly prescribed form and are used to lower blood pressure, treat mild heart failure or severe oedema (bodily fluid retention).

How do thiazide diuretics work?

 Diuretics reduce the amount of sodium and water released into the blood stream. As a result of this, the body produces more urine. This means the water levels in the blood are reduced. The bloodstream therefore decreases in volume and the heart no longer has to work so hard to pump blood around the body.

How are thiazide diuretics taken?

Because diuretics can remove potassium from the bloodstream, your GP may prescribe potassium supplements to take alongside your dose.

Diuretics are usually taken in tablet form, although some can be administered via an injection. The effects tend to last for 12 to 14 hours, therefore it is advisable to take the diuretics either in the morning or in the early afternoon. This is to prevent the excess urine produced by the kidneys from disturbing sleeping patterns.

What are the side effects of thiazide diuretics?

Elderly people are more likely to suffer from the side effects of taking diuretics. Pregnant women are warned not to take diuretics, as are sufferers of gout (a condition where crystals form in the joints). Diuretics can also increase sugar levels in the blood, which could lead to diabetes.

GPs will alter prescriptions accordingly and recommend regular blood and urine tests in order to monitor the effects of thiazide diuretics.

Side effects may include:

• An altered level of certain minerals in the body, such as potassium and sodium. Supplements can be taken.
• A feeling of dizziness caused by postural hypotension. Postural hypotension is a lowering of the blood pressure caused by body position.
• Mild gastro-intestinal problems.

Less common side effects may include:

• Blood disorders that can heighten the risk of infection.
• Rashes on the skin.
• Impotence.

Beta-Blockers (beta-adrenoreceptor blocking drugs)

Beta-blockers are taken to treat a number of conditions. Firstly they can reduce the risk of a heart-attack patient suffering a repeat heart attack. Beta-blockers can also lower blood pressure and help treat a disturbed heartbeat rhythm (arrhythmia), migraine, glaucoma (eye condition) and heart failure. 

How do beta-blockers work?

There is a chemical messenger in the body known as noradrenaline. Noradrenaline causes the arteries to narrow and this cause the heart to beat faster. Beta-blockers work by intercepting the noradrenaline at particular places in the body known as adrenoreceptors. These places are found in the arteries, on the heart muscle and on a number of other organs and muscles.

Beta-blockers are most effective when the heart is pumping fast during cardiovascular activity. 

How are beta-blockers taken?

Beta-blockers are always prescribed by the GP and can come in a number of different forms including:

• syrup or solution
• injection
• capsule or tablet.

The effects of taking beta-blockers do not tend to last very long so the recommended dosage is usually 2 a day. 

Stopping beta-blockers suddenly can increase the severity of a condition and its symptoms.

What are the side effects of beta-blockers?

Your GP may want to monitor you closely if you suffer from any of the following conditions:

• Heart failure
• low blood pressure
• slow heart rate
• asthma or other respiratory problems
• narrowing of the arteries that carry blood to the arms and legs (peripheral arterial disease).

Side effects of taking beta-blockers include:

Please note- there are many different types of beta-blocker and this list will not cover all. It is advisable to read the leaflet accompanying your prescription.

• tiredness
• headache
• cold sensation in hands and feet
• impotence
• nightmares or disturbed sleep
• dizziness.

Less common side effects can include:

• visual disturbances
• dry eyes
• indigestion
• wheezing
• rashes on the skin.

Statins

Statins lower the level of cholesterol found the bloodstream. A GP will prescribe statins to people who have previously had a heart attack, a stroke, a TIA, high cholesterol, peripheral artery disease, high blood pressure, angina or diabetes.

How do statins work?

Statins work by reducing the amount of LDL produced by the liver. LDL, or low density lipoprotein, is known as the ‘bad type’ of cholesterol. Cholesterol is a fat known as a lipid that forms part of the outer membrane of every cell in the body.
Protein is the densest substance found in cholesterol. As its name suggests, LDL contains a very low amount of protein and consists mostly of fats. This means LDL is more likely to stick to arterial walls and cause blockages leading to strokes and heart attacks.

Statins block the LDL-producing enzyme in the liver, thus slowing down the body’s production of cholesterol and reducing risk of an arterial blockage. 

How are statins taken?

A low-dose form of statin is available to purchase from pharmacies, however they will not suitably protect a high-risk patient from a heart attack or stroke. If you are deemed to be at high risk from stroke or heart attack, a GP will prescribe a higher dose of statins, usually in the form of tablets or capsules.

Statins should be taken once a day before bed. This is because the liver produces more cholesterol at night.

Pregnant women are advised not to take statins because this type of drug is likely to damage the baby. Statins can harm the liver so precautionary tests should be carried out by the GP before consumption.

What are the side effects of statins?

Side effects of statins are relatively uncommon. When the do occur, they usually include:

• digestive problems e.g. stomach pain, wind, constipation, feeling sick and vomiting
• dizziness
• depression
• extreme tiredness
• disturbed sleeping patterns e.g. nightmares
• extreme fatigue
• headaches.

How can a Nutritionist help you with Heart Disease?

A fatty diet severely increases the risk of heart disease. Research strongly suggests that a bad diet is the main cause of heart disease, above smoking, lifestyle and family history.

So why see a nutritionist? Quite simply, a nutritionist knows what’s good to eat and what’s not. They can offer you expert guidance without the confusion of conflicting theories or commercial dieting fads. 

Everybody’s relationship with food is different. A nutritionist will tailor a nutrition plan to your personal needs and requirements.

A nutritionist can encourage you to lose weight, lower you cholesterol, reduce your risk of dying of heart disease or experiencing a stroke or heart attack, and improve the quality of your life. 

Further Help

• British Heart Foundation

References

¹American Journal of Epidemiology, The diet and 15-year death rate in the seven countries study
²NHS, Coronary heart disease

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All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional. Whilst some people have benefited from nutritional therapy, no claims can be made to treat, cure or heal specific conditions, and we strongly advise individuals with any health problem to seek independent medical advice from their GP before considering nutritional therapy.