Conditions

Chest pain can occur as a result of many problems, but those associated with the heart and lungs are the most severe and can be life threatening. New or unexplained chest pain lasting for more than a few minutes demands immediate medical help, as it could be the sign of something serious. In addition, chest pain associated with other symptoms, such as sweating, nausea, vomiting, shortness of breath, dizziness, light-headedness, irregular pulse and pain that spreads from the chest to shoulder, arms, neck, or jaw, is an emergency situation.

At the emergency department, your doctor will try to determine the cause of your chest pain by reviewing your medical history, performing a thorough physical exam, and order various diagnostic tests such as electrocardiogram, blood tests, chest X-ray, echocardiogram, CT scan, MRI, stress tests and angiogram.

Treatment will depend on the underlying cause of the chest pain. You may be given IV fluids, oxygen and medication to dissolve any blood clots that could be causing the chest pain. Your ER doctor may perform cardiac catheterization, where a flexible tube is guided into the heart through a blood vessel present in the groin or wrist, to open a blocked artery. You also may be transferred to the hospital for further treatment.

What is Shortness of Breath?

Shortness of breath, also known as dyspnea, is discomfort or difficulty in breathing or the inability to get enough air to breathe. It can occur suddenly or gradually over a period of time and can be classified into acute or chronic shortness of breath respectively.

What are the Causes of Shortness of Breath?

The most common causes of shortness of breath are associated with heart and lung conditions and may include:

• Asthma
• Chronic obstructive pulmonary disease (COPD) flare-up
• Stress and anxiety
• Allergies to pollen, dust, or mould
• Anaemia
• Pneumonia
• Low blood pressure
• Croup
• Upper airway obstruction
• Pulmonary embolism
• Pulmonary hypertension
• Pleurisy
• Abnormal heartbeats
• Enlarged heart
• Heart failure
• Heart attack

What are the Symptoms Associated with Shortness of Breath?

Symptoms of shortness of breath that require attention by your physician include:

• Difficulty breathing when lying flat or with mild activities like walking, climbing stairs, etc
• Breathlessness that does not go away even after resting for 30 minutes  
• Chills, high fever, and cough
• Bluish colouration of lips or fingertips
• Wheezing – an abnormal whistling sound that occurs on breathing
• Stridor – a high-pitched noise that occurs on breathing
• Swelling of feet and ankles
• Chest pain or chest tightness
• Abnormal heart rate
• Profuse sweating, exhaustion, or dizziness

What are the Risk Factors of Shortness of Breath?

Some of the commonly known risk factors for shortness of breath may include:

• Chronic lung or heart condition
• Exposure to asthma triggers
• Obesity
• Low haemoglobin level
• Muscle weakness
• Constant stress
• Smoking
• Not physically fit due to illness or lack of exercise

How is Shortness of Breath Diagnosed? 

To determine the underlying cause of your shortness of breath, your doctor will review your symptoms and medical history, perform a physical examination, and may recommend certain diagnostic tests for further verification, including:

• Pulmonary function tests
• Chest x-ray
• Blood tests
• CT scan
• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Exercise stress test

How is Shortness of Breath Treated?

Treatment options for shortness of breath are dependent upon the underlying cause and include:

• Lifestyle changes, such as refraining from smoking
• Avoiding asthma triggers, such as pollen, dust mites, animal dander
• Stress reduction through exercise, meditation, etc
• Oxygen therapy or pulmonary rehabilitation program
• Bronchodilators to relax airways
• Breathing techniques
• Medications
• Weight management

How Can You Prevent Shortness of Breath?

Things you can do to prevent and manage shortness of breath include:

• Getting a routine health checkup
• Following action plan developed by your physician
• Adhering to prescribed medications regularly
• Following a healthy lifestyle by avoiding risk factors associated with shortness of breath such as smoking
• Avoiding exposure to pollutants in the air, indoors and outdoors
• Speaking to your doctor to get acquainted with concerns, worries, or queries related to shortness of breath

What are Heart Palpitations?

Heart palpitations refer to the unusual sensations that feel like your heart is beating abnormally. They may be felt like an accelerated heartbeat, a flutter or a missed heartbeat. The common sites for experiencing symptoms of heart palpitations are the chest, neck or throat. 

Causes of Heart Palpitations

Heart palpitations may be caused due to both heart and non-heart related issues. The common non-heart related causes of palpitations include:

• Intensive physical activity
• Stress, fear and anxiety
• Health conditions like thyroid disease, low blood sugar level, anaemia, dehydration and fever
• Excessive intake of alcohol, caffeine and nicotine
• Certain medications such as asthma inhalers, diet pills, decongestants, and thyroid drugs
• Hormonal fluctuations during pregnancy, menstruation or menopause
• Abnormal electrolyte levels
• Certain nutritional and herbal supplements
• Intake of certain foods that are rich in monosodium glutamate (MSG), sodium or nitrates

The heart-related causes of palpitations include cardiac diseases such as coronary artery disease, heart valve or muscle problems, prior heart attack and heart failure.

Diagnosis of Heart Palpitations

Your cardiologist will enquire about your medical history, symptoms, diet and lifestyle, current medications and perform a physical examination.

Your doctor may order the following: 

• Chest X-ray
• Electrocardiogram that can be performed while you are at rest or exercising 
• Heart ultrasound (echocardiogram). 
• Holter monitoring and event recording, which involve wearing specialised devices which record the electrical activity of your heart 
• Blood tests

Treatment and Management of Heart Palpitations

The treatment of heart palpitations depends on their cause.

• You may be advised on relaxation techniques, Yoga and aromatherapy to release stress and anxiety.
• You should avoid caffeine, alcohol and nicotine.
• Limit your intake of cough/cold medications and herbal/nutritional supplements.
• Follow a healthy lifestyle.
• Your doctor may prescribe medications if you have an abnormal heartbeat (arrhythmia).
• Sometimes, you may be referred to an electrophysiologist, a doctor specialising in heart rhythms.

Prognosis for Heart Palpitations

Heart palpitations are usually not fatal and subside on their own. However, you must be vigilant and visit a doctor if you notice any unusual symptoms along with the heart palpitations like chest pain, shortness of breath, dizziness or fainting as they could indicate an underlying serious heart condition.

Dizziness

What is Dizziness?

Dizziness is a feeling of being faint, woozy, weak or unsteady. It can be associated with more serious conditions, such as a stroke or cardiovascular problems.

Causes of Dizziness

Some of the causes of dizziness include:

• Inner ear problems like benign paroxysmal positional vertigo (BPPV), Eye infection and Meniere’s disease.
• Migraine
• Poor blood circulation
• Neurological conditions
• Medications
• Anxiety disorders
• Low iron levels (anaemia)
• Low blood sugar (hypoglycaemia)
• Carbon monoxide poisoning
• Overheating and dehydration
• Head injury or traumatic brain injury
• Vision problems

Symptoms of Dizziness

Common signs and symptoms of dizziness include:

• False sense of spinning or motion 
• Lightheadedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating and wooziness 

Diagnosis of Dizziness

Your doctor will review your medical history and symptoms and based on this a physical examination will be performed. Your doctor will check your balance while walking and how the major nerves of your central nervous system are working. Tests may be recommended for further analysis and these include:

• Eye movement testing: Your doctor may observe the path of your eyes when you track a moving object and you may be given an eye motion test in which water or air is placed in your ear canal.
• Head movement testing: If your doctor thinks your dizziness is caused by benign paroxysmal positional vertigo, a head movement test will be done to verify the diagnosis.
• Posturography: This test tells your doctor which parts of the balance system you depend on the most and which parts may be giving you problems. 
• Rotary chair testing: This is a mid-frequency test for vestibular function.

Treatment for Dizziness

Dizziness often gets better without treatment. Within a couple of weeks, the body usually adapts to whatever is causing it. Treatment for dizziness depends on the cause of your condition and your symptoms. Treatments include:

• Medications: Your doctor may prescribe medications like antihistamines and anticholinergics to relieve dizziness and nausea, Anti-anxiety medications, water pills for Meniere’s disease, and certain preventive medicine for migraines.
• Head position manoeuvers: In this treatment specific head and body movements encourage the inner ear to reabsorb any matter that's floating in the inner ear and causing vertigo.
• Balance Therapy: This therapy helps you with dizziness from inner ear conditions.
• Psychotherapy: This type of therapy may help you with dizziness caused by anxiety disorders.

Prevention

Steps to reduce dizziness or falling sensations include:

• Practice exercises that can improve balance, such as yoga.
• Drink plenty of water.
• Get enough sleep.

Cardiovascular Risk Evaluation and Modification

Coming Soon

• Angina
• Myocardial Infarction

Introduction

Arrhythmia is a disorder characterized by abnormal heart beat such as beating too fast, too slow or irregularly. During arrhythmia, as the heart is not able to pump enough blood to the body, it can lead to organ dysfunction or damage. Most arrhythmias are harmless; however, some are more serious and life-threatening.

Physiology of the heartbeat

The heart is a strong, muscular pump that pumps blood across the body. When your heart beats, the electrical impulses that coordinate your heartbeats usually follow a precise pathway through the heart. Any disruption in these impulses can result in arrhythmia.

Types of arrhythmias

There are different types of arrhythmias. Arrhythmias are classified by where they originate (atria or ventricles) and the speed of heart rate.

• Atrial fibrillation: irregular contraction of upper heart chambers
• Bradycardia: slow heart beat
• Conduction disorders: abnormal heart beat
• Premature contraction: early heart beat
• Tachycardia: fast heart beat
• Ventricular fibrillation: irregular contraction of lower heart chambers

Causes

A heart attack or other conditions such as high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland, and congenital heart defects that damages the heart's electrical system can cause arrhythmias.

Smoking, excess consumption of caffeine or alcohol, high stress, and certain medications can also lead to arrhythmias.

Symptoms

Symptoms of arrhythmia can range from mild to severe. Some of these symptoms can go unnoticed, but those that show up include:

• Chest pain
• Paleness
• Sweating
• Light-headedness, dizziness or fainting
• Fainting
• Shortness of breath

Diagnosis

To diagnose a heart arrhythmia, your doctor will collect detailed information about your family's medical history, medications, health problems, and health habits. Your doctor may also carry out a physical examination, during which the doctor will listen to your heart and check your pulse to measure your heart rhythm and heart rate.

Your doctor may order other tests such as:

• Electrocardiogram (ECG): a painless test that detects and records your heart's electrical activity
• Holter monitor: a portable machine that records your hearts activity over a 24-hour period
• Coronary angiography: a procedure which uses a special dye and X-rays to view the pattern of flow of blood to the heart
• Chest x-ray to check for heart enlargement
• Blood tests to measure blood levels of potassium and thyroid hormone
• Echocardiography to view the size, structure and movement of the heart
• Stress test to determine irregular heart rhythms during exercise
• Electrophysiology study (EPS), where wire electrodes are placed in the heart to measure the electrical activity

Treatment

Arrhythmia can be treated with medications, an implantable cardioverter defibrillator (ICD) or pacemaker, or sometimes surgery to restore a normal heart beat.

Catheter ablation: It is a procedure that uses radiofrequency energy to destroy abnormal heart tissue that is causing your heart rhythm problems.

The heart is an organ that pumps oxygen-rich blood to every cell in the body. The human heart is divided into four chambers, two superior atria and two inferior ventricles that are connected by four valves (mitral, tricuspid, aortic, and pulmonary). The heart valves permit the unidirectional flow of blood between the chambers of the heart.

Valvular heart disease (VHD) occurs when your heart valves do not function properly. Any damage or defect of the valve causes an abnormal blood flow through the heart. Types of heart valve disease include:

• Valvular stenosis is the narrowing of any of the heart valves causing obstruction of blood flow.
• Valvular regurgitation or incompetence, also known as leaky valve is a condition in which the valves do not close completely and allow the blood to leak backwards into the heart.

The major causes of valvular heart disease include:

• Congenital heart disease (abnormal valves present at birth)
• Rheumatic fever
• Heart muscle disease (cardiomyopathy)
• Heart attack
• Advanced age
• Infection of the heart valves (endocarditis)
• High blood pressure
• Radiation therapy used to treat cancer

The symptoms of a valvular heart disease include:

• Shortness of breath
• Weakness or dizziness
• Chest pain and discomfort
• Heart palpitations
• Swelling of ankles, feet, or abdomen
• Sudden weight gain

The diagnosis of VHD is based on your symptoms, medical history, and physical examination.

The examination includes inspection, palpation, and auscultation of the heart. Your doctor listens to your heart sounds using a stethoscope. A murmur is an abnormal heart sound heard when the blood flows through a stenotic or leaky valve. Your doctor may order a few diagnostic tests such as:

• Echocardiography is an imaging test that uses sound waves to examine the heart anatomy and its functions.
• Electrocardiogram (ECG or EKG) is a test that records the electrical activity of the heart.
• Cardiac or treadmill stress test is used to determine the effects of exercise on the heart. It provides your doctor with information about your blood pressure, heart rate, and respiratory rate.
• Cardiac catheterization or Angiography is a diagnostic test performed to assess the heart and blood vessel conditions. A thin flexible catheter is placed through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the heart blood vessel to be viewed, a contrast material is injected and X-ray images are taken.

The treatment of valvular heart disease depends on the cause and severity of the symptoms.

• Lifestyle modifications such as eating a healthy diet low in salt and fat, exercising regularly, maintaining a healthy weight, quitting smoking, and managing stress will help slow the progression of your heart disease.
• Your doctor may prescribe medications to improve your cardiac health.
• Surgery is indicated when conservative treatment measures fail to relieve cardiac symptoms. The surgical options depend on the patient's age and health status and may include:

-Percutaneous balloon valvotomy is a procedure in which a balloon is placed across the stenosed valve and inflated. This results in widening of the valve and improved blood flow.

-Minimally invasive heart valve surgeries to repair or replace the damaged heart valves are of two types: Valve Repair: This is often performed for valves with mild to moderate damage.

Valve Replacement: This is performed for seriously damaged valves. Here the diseased valve is removed and replaced with a new valve. The replacement valves can either be biological or mechanical valves.

The need for heart valve repair or replacement depends on many factors, such as the type, cause, and severity of the valve disease, the symptoms, and general overall health of the patient. Valvular surgery helps to reduce the symptoms and improve quality of life.

What is Cardiomyopathy?

Cardiomyopathy is a heart disorder that weakens your heart muscle leading to inefficient pumping of the blood to the rest of your body. 

Types of Cardiomyopathy

Cardiomyopathy can be classified into the following types:

Dilated Cardiomyopathy
This is caused due to enlargement of the ventricles in your heart. This is common in the middle-aged population, especially men, and is usually caused due to a heart attack or coronary artery disease.

Hypertrophic Cardiomyopathy
This is caused due to abnormal thickening of the heart muscle, especially the left ventricle (the left lower chamber of the heart). This may be due to a genetic mutation or an inherited condition. 

Restrictive Cardiomyopathy
This is caused due to loss of rigidity and elasticity of your heart muscle. As a result, your heart can't expand and refill with blood between heartbeats. This is common in the older population. 

Arrhythmogenic Right Ventricular Dysplasia
This commonly occurs due to genetic mutations which result in scarring of the right ventricle. This leads to the development of an abnormal heart rhythm. 

Unclassified Cardiomyopathy
Other types of cardiomyopathy that cannot be classified under any of the above categories belong to this group.

Causes of Cardiomyopathy

The different factors contributing to cardiomyopathy include:

• Heart conditions such as chronic high blood pressure, valve defects, tissue damage from a heart attack, and hemochromatosis (accumulation of iron in your heart muscle)
• Metabolic disorders such as diabetes, thyroid disease or obesity
• Lack of essential vitamins or minerals
• Infections, especially those affecting your heart
• Pregnancy complications
• Excessive alcohol consumption
• Misuse of drugs like steroids, cocaine, cancer medications
• Amyloidosis: accumulation of abnormal proteins

Symptoms of Cardiomyopathy

Initial stages of cardiomyopathy remain asymptomatic. However, as the disease progresses, it may display symptoms including: 

• Swelling in your legs, ankles and feet
• Breathlessness upon exertion or at rest
• Abdominal bloating due to fluid accumulation
• Chest discomfort
• Abnormal heartbeats
• Cough
• Fatigue
• Dizziness and fainting

Complications of Cardiomyopathy

Cardiomyopathy, if left untreated, can lead to other problems such as the formation of blood clots in your heart, cardiac failure, valve problems, and even sudden death.

Diagnosis of Cardiomyopathy

Your diagnosis will be based on your symptoms and personal and family medical history. Your doctor may order diagnostic tests such as a chest X-ray, CT scan, MRI, electrocardiogram, echocardiogram, coronary angiogram, treadmill stress test, cardiac catheterization, blood tests, and genetic testing or screening to confirm cardiomyopathy.

Treatment of Cardiomyopathy

Mild forms of cardiomyopathy may be treated using healthy lifestyle changes and medications. If your condition fails to improve, your cardiologist may recommend devices including:

• Pacemaker: A small device placed under the skin in your abdomen or chest to control arrhythmias using electrical impulses
• Ventricular Assist Device (VAD):  helps with blood circulation through your heart
• Implantable Cardioverter-Defibrillator (ICD): monitors your heart rhythm and controls abnormal rhythms through the transmission of electric shocks when needed

Ablation techniques involve burning or destruction of the abnormal heart tissue that is responsible for the abnormal heart rhythm.

Surgery may be recommended for advanced cases of cardiomyopathy. The different types of surgery for cardiomyopathy include:

• Septal Myectomy: This is an open-heart surgery and involves removal of a part of the septum or wall that divides the bottom two chambers of your heart. This improves blood flow through your heart and minimises backflow of blood.
• Heart Transplant: This involves replacing your failing heart with another person’s (donor’s) healthy functioning heart. Transplants are performed when all other means of treatment fail to improve your condition. 

Management of Cardiomyopathy

In addition to seeking treatment from your doctor, you should follow these tips to manage your condition and avoid further complications:

• Consume a healthy diet
• Perform regular exercise
• Get sufficient sleep
• Keep stress at bay
• Stay away from alcohol
• Control your cholesterol, blood pressure and diabetes

Hypertension is characterized by a high blood pressure (BP).

BP is the force existing in the walls of arteries due to blood flow.

• The normal BP is 120/80mmHg (120 denotes systolic blood pressure and 80 denotes diastolic blood pressure).
• If BP is more than 120/80mmHg, but below 140/90mmHg, then that condition is called as pre-hypertension.
• If BP is more than 140/90mmHg, then that condition is considered as hypertension.

Causes of hypertension

Based on the cause, hypertension can be classified as either essential (unknown cause) or secondary (specific cause).

The main causes of hypertension are:

• High intake of sodium (>1500mg/day)
• Older age and stress
• Smoking and alcohol consumption
• Adrenal and thyroid gland problems
• Chronic kidney disease
• Increased cholesterol
• Diabetes
• Vitamin D deficiency
• Drug use (e.g., Steroids)

Symptoms

In general, hypertensive patients may not have any symptoms. But, some patients might complain severe headache, nausea or vomiting, confusion, changes in your vision, etc.

Diagnosis

Hypertension is diagnosed by measuring the persistent elevation of blood pressure.

Treatment:

Treatment of hypertension includes:

• Life style modifications
  • Reduce the salt intake
  • Maintain normal body weight
  • Avoid stress
  • Avoid smoking and drinking alcohol
  • Do exercise
  • Consume a diet rich in fruits, vegetables, and with low fat
• Drugs

If hypertension is not controlled even after modifying life style, then drug are recommended to reduce blood pressure. There are different drugs available to reduce blood pressure. According to the requirement, physician will prescribe either single drug or a combination of two or more drugs.

The common drugs used to reduce blood pressure are diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).

What is Hypercholesterolaemia?

Hypercholesterolaemia is a health condition characterised by higher than normal levels of lipids, especially cholesterol, in your body.  Lipids are a special type of naturally occurring molecule with high solubility in organic (nonpolar) solvents and low solubility in water. The major lipids present in your body are triglycerides, cholesterol, and phospholipids.

What are the Normal Levels of Lipids?

The normal values for triglycerides are:

The upper limit: 

• 151 mg/dl (1.7 mmol/l)

The lower limit:

• For Women: 50 mg/dl (1.3 mmol/l)
• For Men: 39 mg/dl (1.0 mmol/l)

If your lipid profile indicates any value above the normal limits, chances are you may be hypercholesterolaemic.

Causes of Hypercholesterolaemia

The common causes of hypercholesterolaemia or high level of cholesterols may include:

• Genetics: People with a family history of hypercholesterolaemia may be more prone to developing high cholesterol levels.  This is referred to as familial hypercholesterolaemia.
• Diet and Nutrition: A diet high in saturated fat and refined carbohydrates raises the lipid levels in your body.
• Lifestyle: A sedentary or inactive lifestyle increases your chances of developing abnormal lipid levels.

Signs and Symptoms of Hypercholesterolaemia

High cholesterol levels may be associated with the following signs and symptoms:

• Presence of unusual soft, yellowish lesions on your skin called xanthomas
• Abnormal weight gain
• Impotence in men
• Dizziness
• Slurred speech
• Unsteady gait
• Pain in the lower legs

Diagnosis of Hypercholesterolaemia

A diagnosis of hypercholesterolaemia is based on the results of a blood test called a lipid profile which measures your total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. 

Treatment Options for Hypercholesterolaemia

The treatment approach used for correcting elevated blood lipid or high cholesterol levels includes:

• A heart-healthy diet containing plenty of fruits and vegetables
• An active lifestyle with plenty of cardiovascular exercises
• Drugs to lower your blood lipid levels including statins, bile acid sequestrating agents and other nutraceuticals
• Managing existing health conditions like diabetes, hypothyroidism, liver, kidney and heart conditions that may lead to high cholesterol levels

For severe cases, where conservative treatment fails to provide relief, your surgeon may suggest a liver transplant or bariatric surgery to control your symptoms and treat your condition.

Risks and Complications Associated with Hypercholesterolaemia

A small amount of cholesterol is necessary for the maintenance of healthy cell functions and the production of hormones. Yet, excess cholesterol can be detrimental for your health.

It may start accumulating in the arteries making them narrower. As a result, the heart has to work harder to pump blood throughout your body and the narrowing of the arteries may lead to a heart attack.

Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. As a result, the kidneys start retaining fluid in the body. Congestion occurs when the retained fluid builds up in the organs of the body and the condition is described as congestive heart failure.

In most cases, heart failure is a chronic, long-standing and on-going condition but it can develop suddenly. A person may experience heart failure because of structural changes in walls of heart chambers or improper functioning of valves.

Any factor that increases the workload of heart muscles is the risk factor for heart failure. Some of these causes include:

• Coronary heart disease: It is a condition of narrowing of arteries because of plaque build-up on vessel walls which reduce the blood supply to the heart muscle.
• History of heart attack
• Uncontrolled High blood pressure
• Uncontrolled diabetes

Other causes of heart failure include valvular heart disease, such as aortic stenosis, congenital heart defects, cardiomyopathy - disease of the heart muscle, lung diseases, arrhythmias (irregular heartbeat) and chronic alcoholism.

The "failing" heart continues to work but not as efficiently as it should. People with heart failure cannot exert themselves because they experience shortness of breath and get tired easily.

Common symptoms of heart failure are:

• Fatigue
• Breathlessness and difficulty in breathing
• Weight gain because of retention of fluids
• Inability to lie down flat on bed because of fluid retention in the lungs
• Swelling in the legs (oedema)

Your doctor will diagnose heart failure based on your medical history alone but may also ask you to undergo a series of diagnostic tests.

• Medical history: Medical history includes physical examination, questions regarding your symptoms, personal history and family history of any heart disease.
• Chest X-ray: A chest X-ray can show if your heart is enlarged and if you have fluid accumulation in and around your lungs.
• Electrocardiogram: Electrocardiogram is done to measure the electrical activity of your heart. It provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart.
• Echocardiogram: Echocardiogram is a test that uses sound waves to create a moving picture of the heart. These ultrasound images help to identify abnormalities in the heart muscle, valves and fluid that may surround the heart.
• Nuclear heart scans: This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye is injected into your bloodstream and a special camera is used to see the dye and find out areas of reduced blood flow.
• Angiography (Cardiac Catheterization): Angiography is a test that enables your doctor to take X-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and X-ray images are taken.

The management of heart failure includes general management, medications and surgery.

General Management

• Reduction of physical activity reduces demand on the heart
• Dietary modifications - low salt and low-fat diet
• Losing weight if you are overweight
• Quitting smoking
• Alcohol restriction

Medications

The medications that may be prescribed include:

• ACE inhibitors – Angiotensin-converting enzyme (ACE) inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body. ACE inhibitors include ramipril, captopril, enalapril, lisinopril and perindopril.
• Angiotensin receptor blockers (ARBs) - Angiotensin-2 receptor blockers (ARBs) work in a similar way to ACE inhibitors and include candesartan, losartan, telmisartan and valsartan.
• Cardio selective beta blockers - These agents slow down the heart rate, reduce the heart's need for oxygen and improve the supply of blood to the heart muscle.
• Mineralocorticoid receptor antagonists (MRAs)- MRAs make you pass more urine, help lower blood pressure and reduce fluid around the heart. The most widely used MRAs are spironolactone and eplerenone.
• Diuretics - These agents promote salt and water excretion by the kidneys. This reduces the workload of the heart and symptoms of fluid retention. They help relieve shortness of breath and leg swelling.
• Ivabradine – Ivabradine helps slow your heart rate and is used if you are unable to take a beta blocker.
• Sacubutril/ Valsartan – Sacubitril valsartan is a single tablet that combines an ARB and a medication called a neprilysin inhibitor. It is suitable for people with severe heart failure, whose heart is only able to pump a reduced amount of oxygenated blood around the body despite taking other medication.
• Hydralazine with nitrate – These help relax and open up blood vessels.
• SGLT2 inhibitors – These are drugs used to lower blood sugars but have also been shown to benefit patients with heart failure, improving their symptoms and reducing hospitalisation. Empagliflozin and Dapagliflozin are SGLT2 inhibitors.
• Digoxin - Increases the ability of the heart muscle to contract properly and prevent heart arrhythmias.

Surgery

Left ventricular assist device: A mechanical heart pump called a left ventricular assist device (LVAD) which helps to pump blood from the heart to the rest of the body can be implanted until you have surgery or also as a long-term treatment.

Cardiac transplantation: Cardiac transplantation is the process of replacing the failing heart and with a healthy donor heart. The donor heart is usually collected from a person who has been declared clinically brain dead. It is recommended in younger patients with severe heart failure and life expectancy less than 6 months.