Heart Disease: Symptoms, Causes and Prevention

Cardiovascular disease (CVD) accounted for 32% of global deaths in 2021, and is the leading cause of death across the world. Of the 17.9 million people who died from CVD, 85% succumbed to heart attack and stroke.

Based on Singapore’s statistics in 2022, CVD accounted for 31.4% of all deaths in Singapore; this means 23 people died of CVD every day. Males are slightly more likely than females to die because of CVD; in 2022, 14,601 males died compared to 12,289 females. Because of these alarming statistics, it is important to learn and recognise the symptoms of heart disease, and recognise how to prevent them.

What is Heart Disease?

Heart disease refers to any problem involving the heart. There are several types of heart disease. Some examples are heart attack and heart failure.

Types of Heart Disease

1. Coronary Artery Disease

Coronary artery disease (CAD), also known as coronary heart disease or ischemic heart disease, is the buildup of plaque in the coronary arteries, which are the blood vessels that transport blood to your heart. As the coronary arteries get narrower, blood flow to the heart is obstructed, and your heart muscles start to die due to the lower supply of oxygen.

The main cause of CAD is atherosclerosis. It is the buildup of plaque in the blood vessels, and is usually associated with high blood cholesterol. Other risk factors include diabetes, heavy smoking, physical inactivity and adverse physical reactions to mental stress.

Some symptoms of CAD are:

Angina

Angina is a squeezing chest pain, and it is a signal that the heart is not receiving sufficient oxygen. It is often associated with exertion and fades away with rest. Angina can also occur even while resting or be provoked by emotional stress. The pain may radiate to the abdomen, neck, jaw and upper left part of the body. There are a few kinds of angina, such as silent, stable and unstable angina.

Silent angina, as its name suggests, means that the person does not experience any sort of pain or discomfort. Stable angina refers to periodic chest pain/discomfort in a regular pattern, while unstable angina refers to discomfort that is more serious and the patient may experience sharp pain. This however does not mean that all chest pains are caused by CAD.

Heart Attack

Heart attack could occur when the heart is not receiving enough blood supply suddenly and the heart muscles start to die. The pain is similar to an angina, but lasts longer than a typical angina¹, and is often accompanied by sweating, weakness and laboured breathing.

2. Congenital Heart Defects

A congenital heart defect is when a person is born with a heart defect. There are several types of congenital heart defects, and it is possible to be born with more than one defect. Depending on the severity of the heart defect, the child may need to undergo surgery. Some common congenital heart defects are:

• Hole in the Heart – Depending on the location and size of the hole, the heart may immediately need to be repaired.
• Aortic Stenosis – The aortic valve in the heart could be too narrow. This results in the left ventricle of the heart having difficulties pumping blood through the narrowed aortic valve. This means that pumping blood is arduous for the heart.
• Tetralogy of Fallot – This heart defect features four heart problems: A hole between the ventricles of the heart, a narrowed pulmonary valve, overly thickening of the muscle at the right chamber of the heart and the aorta straddling both ventricles instead arising from the left ventricle.

Symptoms of Congenital Heart Defects

While there are more types of congenital heart defects than the ones listed here and each presents itself differently, some symptoms of more severe congenital heart defects are:

• Tiredness
• Shortness of breath
• Blue skin, fingernails and lips – blue baby caused by lack of oxygen in the blood
• Heart murmur
• Rapid breathing
• Chest pain

Causes of Congenital Heart Defect

It is not known why exactly congenital heart disease occurs; however there are risk factors that increase the likelihood of the child developing a congenital heart defect, such as smoking during pregnancy, excessive alcohol or drug consumption during pregnancy, certain medications, and viral infections, most commonly rubella measles.

Genetic factors could also contribute to the likelihood of developing congenital heart disease, such as Down syndrome and DiGeorge syndrome².

3. Heart Attack

Heart attack, also known as myocardial infection, is the sudden obstruction of coronary arteries, which blocks the blood flow to the heart. It is usually caused by atherosclerosis. Part of the heart muscles die due to oxygen deprivation. This results in myocardial infarction. The risk factors are high blood pressure, high blood cholesterol, diabetes, obesity or overweight, smoking, etc.

Symptoms of a heart attack include shortness of breath, heartburn and sweating. Chest pain that lasts at least 20 minutes is also a common symptom. Heart attacks however could present themselves differently for each patient. For example, a diabetic patient would usually suffer a silent heart attack without any chest pain. Read more about heart attacks here.

4. Arrhythmia/Abnormal Heart Rhythm

Heart arrhythmia means irregular heartbeat. Simply put, arrhythmia is a condition about abnormal heart rhythms. It is caused when the natural electrical conduction system of the heart malfunctions. Heart arrhythmia could either be harmless or life-threatening.

There are two types of heart arrhythmia:

Bradycardia (Abnormally Slow Heart Rate)

Patients with bradycardia have a heart rate of about 40 to 50 beats per minute. The symptoms include dizziness, fatigue and fainting as the heart does not pump enough blood to vital organs and the brain. However, bradycardia may be normal for physically fit people and athletes.

Tachycardia (Abnormally Fast Heart Rate)

Patients with tachycardia on the other hand have a heart rate of over 100 beats per minute. The symptoms of tachycardia are similar to those of bradycardia, and these include dizziness, fatigue, palpitation and fainting. Tachycardia could occur in the atria or ventricles.

Atrial tachycardia occurs when the patient has over 100 irregular beats per minute while at rest; this is known as atrial fibrillation. It occurs when the atria are enlarged by heart valve disease, hypertension, inflamed or damaged by CAD. If left untreated, atrial fibrillation could increase the risk of stroke.

Ventricular tachycardia is when the ventricles beat too rapidly, and the heart cannot fill itself with blood in time between beats. It could develop into ventricular fibrillation, and is much more serious than atrial tachycardia and could be fatal.

Causes

There are a few causes of heart arrhythmia, and these include smoking, alcohol, caffeine, diet pills ³ and some viral infections.

5. Congestive Heart Failure

Congestive heart failure, a term used interchangeably with heart failure, is a progressive condition with no cure. It does not mean that the heart has failed to stop working; rather it means the heart is unable to pump blood to the rest of the body efficiently.

Congestive heart failure occurs when blood backs up to the heart through the veins as the heart is unable to pump out the blood from the veins effectively into the arteries ⁴. This leads to leakage of fluid into other parts of the body, such as lungs, liver and lower body, which can cause swelling and other complications.

Some symptoms of congestive heart failure include weight gain, shortness of breath, fatigue and increased need for urination.

Common causes of congestive heart failure are:

• High blood pressure
• Coronary artery disease
• Cardiomyopathy
• Damage to heart valves

6. Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy strikes when the heart muscle thickens for no apparent reason. The thickened heart muscle makes it difficult for the heart to pump blood as efficiently; causing the body to receive less oxygen-rich blood. The thickening of the heart muscle usually occurs in the left ventricle of the heart, but it could also occur in the septum (the muscle between the left and right side of the heart).

Hypertrophic cardiomyopathy is usually passed on through genetics, and a child has a 50% chance of inheriting this condition. Symptoms of hypertrophic cardiomyopathy include chest pain, lightheadedness, fainting, palpitations and shortness of breath⁵.

7. Mitral Valve Regurgitation

Mitral valve regurgitation (MVR) is the process of blood leaking backwards into the left atrium through the mitral valve when the heart contracts. This happens when the mitral valve in the heart does not close fully, and therefore, as a result of the leakage, the heart has to work harder to compensate for the lower amount of blood supplied to the body. It could lead to complications such as atrial fibrillation, which increases the risk of blood clots, sudden cardiac arrest, pulmonary hypertension and heart failure.

Mitral valve regurgitation is usually a result of mitral valve prolapse. Another common cause of MVR is rheumatic heart disease, or rheumatic fever, where the heart becomes inflamed due to an infection.

Symptoms of MVR are shortness of breath, the feeling of being overwhelmingly fatigued and heart palpitations⁶.

8. Mitral Valve Prolapse

Mitral valve prolapse (MVP) is another type of mitral valve disease, and it is when the mitral valve fails to close fully because of the extra tissues in the mitral valve. As a result, these mitral valves bulge into the left atrium of the heart. These bulges could cause the mitral valves to fail to close properly, which in turn causes complications such as mitral valve regurgitation.

Mild MVP is not serious and will usually not have any symptoms. In the case of more serious MVP, the symptoms include dizziness, fatigue, arrhythmia, and shortness of breath even when the patient is lying flat⁷.

9. Aortic Stenosis

Aortic valve stenosis, or aortic stenosis, is the narrowing of the heart’s aortic valve. The aortic valve leaflets stiffen, thicken or fuse because of the buildup of calcium and cholesterol in the valve. The aortic valve is unable to open properly, and thus blocks blood flow to the rest of the body. The heart has to work harder to compensate for the lack of blood pumped to the body, and due to the wear and tear of the heart, the heart muscles are weakened. Aortic valve disease also can be caused by rheumatic fever which is very common in Singapore.

At the beginning of aortic stenosis, there may be no symptoms. As the disease develops, some typical symptoms of aortic stenosis include fatigue, heart palpitations and dizziness. Symptoms such as syncope (fainting), shortness of breath following exertion, and chest pain may be signs of more serious aortic stenosis.

10. Dilated Cardiomyopathy

Cardiomyopathy is a disease that could thicken, enlarge or stiffen your heart muscles. Dilated cardiomyopathy specifically refers to the thinning and expansion in the left ventricle of the heart. As each beat is done with less force, more blood remains in the heart, and causes complications such as a heart failure.

The cause of dilated cardiomyopathy is usually unknown; however, if detected it is usually caused by excessive alcohol use, chemotherapy drugs, diabetes and uncontrolled high blood pressure. Dilated cardiomyopathy could also run in the family.

A heart murmur is normally the first noticeable sign detected by a stethoscope. Symptoms include dizziness, fainting, unexpected weight gain and swelling in the legs and feet due to fluid retention⁸.

Symptoms of Heart Disease

Heart disease comes in many different forms. While heart disease symptoms vary for each form of heart disease, there are some common symptoms, such as chest pain, shortness of breath, fatigue, heart palpitations, dizziness and swelling in the legs and feet.

In a heart attack, the symptoms could be displayed differently in men and women. Women may experience more subtle symptoms, such as unusual fatigue and lightheadedness, but both men and women still experience common symptoms such as cold sweat, chest pain and nausea. You can read more about the symptoms of heart attack, stroke and cardiac arrest here.

It is important to see a doctor immediately if you have heart disease symptoms. These show your heart muscles are dying because of the lack of oxygen it is receiving or heart is being overworked, and it could lead to cardiac arrest if left untreated.

Causes and Risk Factors

Similarly, the risk factors for heart disease could be different for each heart disease. In general, it is a good idea to sustain a healthy lifestyle, not just for your heart health but also for your general health. There are risk factors of heart disease that you can manage, such as:

• High Blood Cholesterol
• Physical inactivity
• Unhealthy diet

There are also inherent risk factors, such as:

• Age
• Gender
• Family history

Complications

It is important to manage heart disease before it leads to more serious complications. Aside from heart attacks and heart failure, other complications include:

• Stroke – This happens when the brain is not receiving enough oxygen-rich blood, as the result of the narrowing or blockage of arteries that supply blood to the brain. Brain tissues will start dying within a few minutes of a stroke. A stroke is a medical emergency.
• Peripheral artery disease – The most noticeable symptom is leg pain, and this is because the leg is not receiving enough blood. The problem could occur in the arms too.
• Aneurysm – It is a bulge in the wall of the artery, and could lead to life-threatening internal bleeding if it bursts.

Diagnosis

Many tests are available to diagnose the different types of heart disease. Usually, the doctor will ask for the patient’s medical history and conduct a physical exam before deciding to carry out tests for a heart disease diagnosis. There are two kinds of tests – invasive tests and non-invasive tests. Some non-invasive tests are:

Electrocardiography

Electrocardiography is a method to measure electrical activity in the heart. Electrodes are attached to the arms, legs and chest, and the electrical activity and rhythm are measured via a mission.

The electrocardiogram could provide vital details such as rhythm, heart rate, electrical abnormalities and thickening of the heart muscle. It could also show an ongoing or previous heart attack of the patient.

Blood Tests

During a heart attack when the heart is damaged, substances such as troponin and creatine kinase are released into the bloodstream. Doctors usually test for troponin to detect a heart attack as they are unique to your heart muscle⁸.

Echocardiography

This involves the use of ultrasound to assess the internal structure, movement, chambers and valves of the heart.

Some invasive tests are:

Trans-Oesophageal Echocardiography

In an ultra-sound probe, an instrument is inserted down the patient’s oesophagus to take very clear images of the heart. This is done because part of the oesophagus is near the heart.

Electrophysiologic Study

A catheter is inserted into the vein and carefully threaded through to the heart. The test records electrical activities in the heart, and is used to detect irregular heart rhythms.

You can read about other types of tests here.

Treatments

After going through the test(s), the patient could be recommended treatment based on the severity and symptoms of the heart disease.

1. Lifestyle Changes

Lifestyle changes are usually required alongside treatment that is recommended to help the patient recover from the heart disease. Typical lifestyle changes are quitting smoking, maintaining a healthy weight, becoming physically active, having enough rest, limiting or stopping alcohol consumption, having a heart-healthy diet, monitoring your blood pressure and managing your stress levels. (9) These lifestyle changes could also apply after you have recovered from heart disease or condition, and help prevent the risk of heart disease. View our page on heart smart eating habits and healthy living for some tips.

2. Medications

There is a wide range of medications available, and the doctor prescribes medication according to your medical conditions and type of heart disease. There are a few common medications prescribed:

Anti-coagulants

Anti-coagulants are also known as blood thinners. These help prevent more blood clots from happening, and curb existing blood clots from enlarging. Anti-coagulants help to obstruct a blood clot by forestalling fibrin from forming. An example is warfarin.

Angiotensin II Receptor Blockers

These help to keep blood pressure from rising further; they block angiotensin II from affecting the heart and blood vessels.

Vasodilators

Vasodilators could help to lower blood pressure by dilating the blood vessels so blood flows more easily. This helps to ease the burden on the heart¹⁰.

There are many other types of medications that a doctor may prescribe. Read more about it here.

3. Surgery

If the condition is more severe and medication is not sufficiently effective, surgery may be recommended to treat the heart disease or heart condition. Some common surgeries are:

Coronary Artery Bypass Grafting (CABG)

This procedure involves creating new routes around the blocked paths at each of the blocked coronary arteries. It is typically done by using a healthy blood vessel from another part of the body. The healthy blood vessel is used as a graft to bypass the blocked section of the coronary artery to ensure improved blood flow.

Repair Surgery

A surgeon could repair aneurysms, and congenital heart defects and resolve other problems with the heart.

Stent Implantation

A stent is placed in an angiopathy balloon and inserted into the blockage at the coronary artery. The success rate of this surgery is close to 90%, and reduces the chance that the coronary artery narrows again.

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Similar to the stent implantation, a balloon is inserted into the blockage site in the coronary artery. The balloon is inflated and deflated several times to push deposits into the coronary artery walls.

Device Implantation

A pacemaker is used to regulate heartbeats for patients with serious abnormal heart rhythms (arrhythmia). It is inserted just beneath the skin. A defibrillator is used to restore normal heart contractions when life-threatening abnormal heart rhythm occurs¹¹.

What is Cardiac Rehabilitation?

Cardiac rehabilitation is a well-established form of treatment suitable for almost all heart conditions, including heart attacks, coronary artery disease, valvular heart disease and even heart failure. The overall goal of cardiac rehab is to improve the patient’s heart health and well-being and thus prevent the recurrence of a cardiac incident.

The three components of Cardiac Rehabilitation are:

• Supervised Exercise Sessions – A vital part of cardiac rehabilitation that ensures the patient’s safety and helps them build confidence and fitness following a cardiac event.
• Counselling – Provides emotional support and advice to patients and their families in coping with lifestyle changes, treatment fees, etc., on the road to recovery.
• Patient Education – Information on heart disease conditions, treatment and risk factor modification empowers patients to care for themselves.

Find out more information about cardiac rehabilitation.

Conclusion

In conclusion, it is important to learn about and recognise the symptoms of different heart disease; this is to prevent further damage to the heart and the body. It is also important to learn about the causes and risk factors of heart disease, and be aware that one of the major risk factors is your family health history; stop smoking, stay physically active and watch your diet and weight. Indeed, you can take steps to prevent heart disease.