ANGINA & HEART ATTACK (MYOCARDIAL INFARCTION)
Dr. Richard Mansfield
BSc (Hons) MB ChB MD FRCP FESC
CONSULTANT CARDIOLOGIST
Note: I am happy to answer general questions regarding the content of this website, but I cannot give clinical advice. Such requests will not be answered.
Breathlessness is a common symptom presenting to cardiac clinics and may be due to a number of things including a lack of physical fitness, but importantly may be due to lung disease, narrowed heart arteries, anaemia, heart rhythm problems or heart failure. The term heart failure is used when there is a reduction in the normal pump function of the heart.
Systolic heart failure occurs when the heart is weakened and is not able to pump enough blood around the body. This occurs when the heart muscle is damaged such as after a heart attack or may be due to a primary problem with the heart muscle such as is seen in degenerative conditions called cardiomyopathy. It often presents with breathlessness, fatigue and ankle swelling.
Diastolic heart failure occurs when the heart cannot relax properly after it has pumped blood into the aorta. The heart is stiff and so does not fill properly. This is commonly due to the effects of coronary artery disease and high blood pressure (hypertension). As with systolic heart failure this may present with breathlessness, fatigue and ankle swelling.
A number of blood tests will be required to test for anaemia and assess thyroid and kidney function. Your doctor may request a blood test called Brain Natiuretic Peptide (BNP), which is often elevated if there is a cardiac cause for breathlessness An ECG will be recorded. It is usual to have a chest X-ray to assess the heart size and to see if there is any fluid on the lung. An echocardiogram is essential. This produces clear pictures of the heart and helps to differentiate systolic from diastolic heart failure. It may be necessary to have a coronary angiogram it is quite common to have a cardiac MRI scan.
If all the tests looking for evidence of heart failure are normal then additional investigations into the cause of breathlessness may be needed. These could include a test of lung function or a chest CT scan to look for blood clots (pulmonary emboli).
Most patients will require some tablet treatment. Water tablets or diuretics (such as furosemide) will be prescribed if there is any sign of fluid retention. It is usual to start patients on an ACE inhibitor, which strengthens the heart. Many patients will also be started on a beta-blocker (commonly bisoprolol), as well as a different water tablet called an aldosterone antagonist (spironolactone), which with ACE inhibitors have been shown to improve outcome.
A new drug is available called Entresto, which is used in place of ACE inhibitors. Some patients may be considered for a special type of pacemaker known as Cardiac Resynchronisation Therapy (CRT). This pacemaker is intended to restore a more coordinated and equal contraction to both sides of the heart and in so doing improve the cardiac output.