Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, Warrick Bishop here and thank you for joining me on my podcast and videocast station. I really do appreciate you taking the time to listen and I... really do hope you find the information interesting and informative. Today I'd like to talk about heart related symptoms. Well everyone knows that you get chest pain and shortness of breath if you've got a heart problem but I'd like to dive just a little bit deeper. Let's break it down to how we think about the heart as a engine. So I've used the analogy over and over before, but if we think about the heart a little bit like we would a car engine, then there's an electrical system, obviously, that keeps the timing in the car and in the heart. There are pistons and valves. They are the engine block of the heart or the engine block of the car. In our heart, we've got pistons, which are the muscles that contract, and we've obviously got... Valves that direct flow. And we've got fuel lines in our car to deliver petrol to each cylinder. And we've got fuel lines in the heart to deliver blood to the heart muscle or myocardium so that it can do its work. So let's walk through these and think about the symptoms that could arise from where we have problems with any of those particular systems breaking down. Let's start with the electrical system. There's a couple of ways the electrical system can play up. A little bit like your car. It could over-rev or it could be flat altogether. Well, let's talk about that for people. What people will describe as a symptom is a palpitation if the heart's racing. So they'll feel a fluttering in the heart. And sometimes this can give us a clue as to what's going on underneath. Even without the benefit of an electrical ECG tracing. Now I will underline the importance of an electrical ECG tracing. Because without that we can't actually get the identification thumbprint of the palpitation. Which we need to make the diagnosis. But a description can be really helpful. Some people will describe a palpitation or a fluttering in the chest which comes and goes. thumps and bumps here and there often when they're resting and this can be an extra beat or an extra couple of beats. These are called atrial extra beats if they arise from the atrial muscle or they can be ventricular ectropic beats if they arise from the lower part of the heart. So extra beats are pretty common and patients will feel a thump or a bump or even a fluttery sensation in the heart. Patients will also describe palpitations that may last a longer period of time. And if the patient describes a palpitation that's fast and regular, and often I'll get patients to tap out what they feel. So if they tap out something like this, fast and regular, we might think that that is a re-entrant rhythm, a short circuit type of rhythm, that we would call a supraventricular tachycardia. If they tap out something that's very irregular and bouncy and fluttery within their chest and feel quite awful with it, that could well be atrial fibrillation. Now, we get these funny heartbeats. They can be generally felt if they're in the top part of the heart. Sometimes the electrical system... will not just lead to a palpitation, but the symptom of presentation may be a blackout. The word we use for blackout is syncope. Syncope meaning a pause. And anyone who does any music would know that a syncopated song or syncopated piece of music is one with lots of pauses in it. So syncope can arise from two issues. One. a complete lack of electrical activity getting from the top of the heart to the bottom of the heart, that would be called a complete heart block. People will black out with that. The other way that we can get syncope from an electrical problem is if the heart goes so fast that someone blacks out. Again, can happen very quickly and can lead to sudden cardiac death in a very short space of time and needs immediate attention. So that's the electrical system too fast, too slow, arising from the top of the heart or the bottom of the heart. Often we'll put monitors in place to try and evaluate exactly what's going on, because unless we get a clear-cut electrical trace, it's often very hard to be 100% sure of exactly what's going on. When we think about the pistons and valves, symptom that points to anything specific so they don't give a they give a very general problem if they're failing so if the heart's not pumping properly or if the valves are causing significant hemodynamic problem then what we see is a Failure of the normal hemodynamics of the heart. If the heart hemodynamics are not working properly, there is often fluid retention. A consequence of fluid retention is extra fluid within the lungs building up, giving rise to shortness of breath, and we can also see extra fluid accumulate in the periphery, principally the ankles and feet, so people may get short of breath and swollen ankles. it won't be clear exactly what's causing that problem. Either the heart muscle not working properly could give rise to that, or a heart valve not working properly could give rise to that. This is why many situations where patients are referred for evaluation, particularly if shortness of breath, we will undertake an echocardiogram, an ultrasound of the heart, to look at the structure and function of the heart so we know exactly what's going on, Most precise about identifying whether it's a muscle, a piston problem if you like, or a valve problem. Is it something to do with the major valves of the heart? So pistons and valves, our engine block, just gives us problems with shortness of breath and swelling in general terms. Of course, if the heart's not working properly, there may well equally be a diminution in exercise capacity. And that means that people may well describe diminished energy and may not be super clear that it's shortness of breath that's leading them to feel that they're just not 100%. So teasing out the history is often very important. Lastly, let's come to the fuel lines or the arteries of the heart. Now, if the fuel lines are problematic, then not enough. fuel gets to the muscle and if not enough fuel gets to the muscle then the muscle literally is starved of oxygen and responds as if it's cramping at least in the first instance and then if there's a complete lack of blood flow to the heart that cramp will then turn to degradation of that tissue what we call myocardial infarction and then death of that tissue we call that necrosis. So when we think about fuel lines, the fuel lines can narrow suddenly. That's a plaque rupturing and blocking an artery completely. The consequence of that, sudden cessation of blood flow to a muscle. That muscle gets starved. It doesn't work properly. It releases chemicals and signals which relate to pain. So a sudden blocked artery. hearts not working properly, some shorts of breath, and pain in the chest. Very clear cut, this is a sort of TV or movie style heart attack that you all will have seen. Individual, often a type A personality male grabbing his chest, short of breath, chest pain, and these people can then go on to collapse if there's a complication by a ventricular rhythm. If those individuals are lucky, they can get to hospital in a short period of time, have that artery opened up. The quicker, the better. So fuel lines, they can block suddenly. They can also block gradually or be narrowed such that if the person walks, say, 100 metres up a gentle incline, as they approach that 100 metre mark, they get tightness in the chest, reflecting that not enough blood is getting through. all the time. That would be called angina and so angina is a relative lack of blood flow to the heart when the heart is under exertion. Interestingly when we look at females presenting with coronary artery disease they don't tend to get as much chest pain and may present simply with shortness of breath as their anginal equivalent. So rather than a lady reporting that they get chest tightness as they walk up a hill they might report that they're more short of breath than would normally be expected. So key symptoms that we would see around heart-related issues, thinking of the heart as an engine with an electrical system, pistons and valves and fuel lines, is we're thinking of palpitations. If the heart's going too fast, we're thinking of blackouts. If the electrical system's playing up, we're thinking of shortness of breath, fluid retention, diminished exercise capacity if the pistons and valves are a problem. And we're thinking of the fuel line that's playing up either suddenly or gradually giving rise to chest pain and shortness of breath. Well, if any of those symptoms are something that you're suffering, please go and get checked out. And not next week. Get checked out now. Because these can be significant indicators of something about to go wrong. Anyway, I hope you found a little bit of a trip around heart-related symptoms interesting. For now, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now. Join the Healthy Heart Network and become part of our growing community. If you're interested in your heart health and risk of heart attack, then join the Healthy Heart Network for only $5 as a lifetime member. This represents $55 worth of value. We offer and help people understand their present state of heart health, what their current level of risk is, and the positive steps they can take to improve their risk of heart attack in the future. Go to www.healthyheartnetwork.com.au and click the Join the Family button.
