Heart conditions

Arrhythmia

If you have been diagnosed with arrhythmia, which is an irregular heartbeat, it does not necessarily mean you need further treatment. Some irregularity is harmless. Ask your doctor if you will need further tests. Ask about the likelihood of needing an artificial pacemaker.

The British Heart Foundation is currently funding studies to discover whether people could be at risk from arrhythmias after taking over-the-counter remedies for common complaints such as hay fever or indigestion. Ask your GP whether you should avoid these products.

In some cases, arrhythmia can be caused by other conditions like anaemia or abnormal thyroid function. Ask your doctor if either of these apply to you.

Almost all patients who have symptoms associated with their palpitations will have an electrocardiogram (ECG), which helps to identify the source of the abnormal rhythm. It is painless and usually takes about five minutes. Ask if you should have an ECG.

If palpitations are a major nuisance or if your doctor is unable to make a definite diagnosis from the ECG tests, you may be advised to have electrophysiological testing (sometimes called an 'EP test'). Ask your doctor if you need one of these.

Sometimes, it is possible to destroy an arrhythmia (an irregular heart rhythm) by radio frequency or 'ablation'. This treatment is carried out with an electrode catheter. The process can take up to three hours but is rarely painful. Ask if this treatment would be suitable for you.

If your palpitations are persistent and troublesome, you may need to take 'anti-arrhythmic' drugs. Ask your GP if this course of treatment would be preferable.

Cardiomyopathy

Dilated cardiomyopathy is not curable, although some patients improve spontaneously. Treatment is usually with drugs, though a small minority of patients deteriorate and require a heart transplant. Ask your doctor if drugs are recommended, and if so, which ones.

Hypertrophic cardiomyopathy, often referred to as HC, is an excessive thickening of the heart muscle. Ask your doctor if you are suffering from this.

Many HC sufferers also get irregularities of the heartbeat. Symptoms such as palpitation may occur, but not often. Exercise testing or monitoring may detect them. Ask your doctor if you require tests or monitoring.

Sometimes electrical cardioversion may be used to shock the heart back into normal rhythm. If this procedure is necessary, it is carried out under general anaesthesia. Ask your doctor what sort of anaesthetic you will need.

Occasionally HC can lead to heart block. This is uncommon, but if this occurs, a pacemaker is implanted. Ask your doctor if this is a risk in your case.

At present there is no cure for hypertrophic cardiomyopathy although there is a slight possibility that some drugs may decrease the degree of muscle thickening. Ask your GP what type of drugs are recommended and why.

There are four forms of cardiomyopathy and can be tested in a variety of ways, including regular monitoring and blood tests. Pacemakers can help, but severe cases require surgery. Ask your doctor which treatment they recommend, and why.

Coronary Heart Disease (CHD)

There are a variety of tests involving a small amount of radioactive (harmless) material being injected into the blood. Its movement can be monitored via a camera or scanning device while you walk, run or lie down.

* An electrocardiogram, or ECG, records the rhythm and electrical activity of your heart. This can be done during a doctor's visit or over a 24-hour period.

* The implantable loop recorder is a relatively new technique for finding out what is causing symptoms that don't happen very often, such as dizzy spells or blackouts.

* Echocardiography is a recorder (probe) that is placed on your chest.

* A catheter test involves electrode catheters being put into a vein in the groin, neck or under the collarbone. They record heart movements.

* Magnetic resonance imaging (MRI) is a technique that produces detailed pictures of your internal organs by putting you within a strong magnetic field. MRI is only available in a few specialised units in the UK. Ask which of these applies in your case and for an explanation of what will be involved in your treatment.

Lots of people live with heart disease, or 'stable angina' for many years. This is when the symptoms can be controlled using medicines. You will also have to make lifestyle changes to make sure you get more exercise and eat healthily. Ask for advice on how to do adopt a more healthy lifestyle.

Risk factors for coronary heart disease include smoking, high blood pressure, high blood cholesterol and physical inactivity as well as obesity, diabetes and family history. Tell your doctor if you think any of these apply to you. Ask how the causes will affect your treatment.

The UK now has a National Service Framework for Coronary Heart Disease. Ask your doctor what this means for you.

You may be recommended for coronary bypass surgery. Ask your GP about whether you are likely to need this operation, and about rehabilitation afterwards.

There are several different types of heart surgery other than bypass. Ask about these procedures to be sure you are getting the one that is best for you.

For very serious coronary heart disease, you may need a heart transplant. These procedures are carried out in eight centres around the country: Harefield and St George's in London, Papworth in Cambridge, the Queen Elizabeth in Birmingham, Wythenshawe in Manchester, the Northern General in Sheffield, the Freeman in Newcastle and the Royal Infirmary in Glasgow. Ask which hospital you will attend if you need a heart transplant, and what their mortality rate is for the operation.

The British Heart Foundation employs seven Patient Network Co-Coordinators who encourage support groups and maintain links with cardiac rehabilitation programmes around the UK. The network works in the community with hospital NHS Trusts and primary care teams. Ask your doctor if there is one near you.

Heart Failure

Some symptoms of heart failure can be caused by other health problems. Ask your GP to do a blood test to check for anaemia, kidney damage and thyroid disease.

Lung diseases can reduce the pump function of the right ventricle and cause the heart to become enlarged, producing symptoms of right heart failure. However, the most common cause of right heart failure is left heart failure. Ask your doctor which side of the heart you are having problems with and what has caused your condition.

Various drugs are used to treat heart failure. Some of these are: diuretics, ACE inhibitors and digitalis. They have all proved very successful in treatment. Ask your GP whether these drugs can be used and which ones are best for you.

Only one in 10 patients being treated for heart failure is prescribed beta-blockers, which are drugs shown to increase the length and quality of life. If your doctor has not prescribed them for you, ask why.

The British Heart Foundation has funded a network of specialist heart failure nurses, who help patients affected by this debilitating condition retain independence in their own homes. Ask your GP if you can apply for one to visit you on a regular basis.

You may need to have a pacemaker implanted if you have 'heart block', or if you have certain types of irregular heart rate or heart rhythm. Ask your doctor if you are likely to need a pacemaker.

If you have serious heart failure, depending on its cause, you may be offered a bypass operation. These have a high success rate and most patients have greatly improved quality of life as a result. Ask your doctor if you need a heart bypass operation.

Whatever your medical treatment, eating a healthy, salt-reducing and cholesterol-lowering diet, plus regular exercise, will reduce your risk of developing further problems. Ask your doctor for advice on how to eat healthily.

High cholesterol

There are two types of cholesterol and your doctor will be able to tell you what level they should be. Ask your doctor to perform a simple blood test that can measure these levels.

You may need to make lifestyle changes, tackle other health problems and possibly take other forms of medication to beat high cholesterol. Ask your doctor what causes your high cholesterol and what you can do to lessen the effects.

Some cholesterol problems are caused because it cannot be cleared efficiently from the blood and therefore accumulates. Ask your doctor if this applies to you and what the treatment should be if this is the case.

One type of cholesterol, called high density lipoprotein, is commonly known as the 'good' cholesterol. Ask your doctor to test for this as well.

Hypertension, or high blood pressure

Everyone who has high blood pressure should make changes to their lifestyle. In some cases these changes can be enough to lower blood pressure to a level where medication may not be needed. Ask your doctor whether simply making lifestyle changes is likely to be enough to counter the problem.

The amount of salt that we eat has a direct effect on our blood pressure. The more salt we eat, the higher our blood pressure. Ask your GP if your hypertension is likely to be caused by excessive salt intake.

Eating at least five portions of fresh fruit and vegetables a day will lower your blood pressure. Ask your GP if you are not sure what constitutes one portion.

Some fruits and vegetables, like bananas, baked potatoes, avocados and dried fruits, contain a lot of potassium. This can be very effective in reducing hypertension. Ask your doctor for a list of high-potassium foods.

If you are taking beta-blockers be aware that these can cause you to put on weight. Ask your GP about side effects of any drugs you have to take.

Some people would like to be able to monitor their own blood pressure at home and many doctors encourage this. Ask your GP how to monitor your own blood pressure.

You may be given tablets if you suffer from prolonged high blood pressure. There are many different types. Ask your GP which ones are best for you, and why. Also ask about possible side effects.

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