Coronary artery disease is often called ischemic heart disease or coronary heart disease. It refers to a reduction in blood supply to the heart muscle or myocardium. This usually occurs due to the formation of plaque within the artery. The plaque itself is composed of cholesterol, blood cells called platelets and calcium. Coronary artery disease can manifest as chest pain on exertion (angina), or when the plaque ruptures and occludes the artery it can cause a heart attack (myocardial infarction). Risk factors include diabetes mellitus, hypertension, hypercholesterolemia, smoking, family history, obesity and a sedentary (inactive lifestyle).

The heart is responsible for supplying oxygen to every cell of the body. When the heart can no longer cater to the needs of the body, this is called heart failure or congestive cardiac failure. Heart failure is either the result of a weakened heart muscle which struggles to effectively pump blood or a heart muscle which is too stiff to allow for relaxation. Factors that can increase the risk of or lead to heart failure are coronary artery disease, hypertension, diabetes, genetics/family history, arrhythmias and thyroid disease.

Patient with heart failure experience:

• Shortness of breath (dyspnoea)
• Fatigue and weakness
• Breathlessness when lying flat (orthopnoea)
• Swelling of the lower limbs (oedema) and abdomen (ascites)
• Rapid or irregular heartbeat (palpitations)
• Other symptoms which may be related to the underlying cause

Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help patients live longer.

The heart has an intrinsic circuit which allows for an organised, synchronised rhythm or heartbeat. An arrhythmia describes an abnormality in the heart’s natural rhythm. Different types of arrhythmias cause the heart to beat too fast (tachyarrhythmia), too slowly (bradyarrhythmia), or in an irregular manner. Patients may experience this as an awareness of the heartbeat (palpitations); reduced effort tolerance and fatigue; dizziness and a brief loss of consciousness (syncope). 

The type of arrhythmia can be determined by means of an ECG, Holter monitor or a loop recorder. Based on the underlying rhythm most arrhythmias can be effectively treated by means of medication, device therapy or electrophysiological studies.

The heart consists of 4 chambers: 2 atria (upper chambers) and 2 ventricles (lower chambers). Between the atria and ventricles, as well as the ventricles and great vessels are valves. Blood passes through a valve as it passes from one chamber to the next, and as it leaves the heart. The valves prevent the backward flow of blood, ensuring that it flows in one direction.

A valve that is diseased or damaged can affect the flow of blood through the heart.  There are two main types of valve problem:

• Valve stenosis. This means that the opening of the valve is narrowed and the valve does not open fully. So, there is some restriction in blood flow through the valve.
• Valve regurgitation (sometimes called valve incompetence, or a leaky valve). This means that the valve does not close properly and there is a backflow of blood through the leaky valve.

Valve disease is commonly a result

1. Rheumatic heart disease.  This occurs as a result of rheumatic fever in childhood.
2. Degenerative changes. Either weakening and or ageing of the valve

Valvular heart disease manifests as a murmur (indicating abnormal blood flow) and patients may experience:

• Shortness of breath (dyspnoea)
• Fatigue and weakness
• Breathlessness when lying flat (orthopnoea)
• Swelling of the lower limbs (oedema) and abdomen (ascites)
• Rapid or irregular heartbeat (palpitations)

The diagnosis and severity of valvular heart disease can be made on echocardiography, and if necessary, the diseased valve can either be repaired or replaced.

Congenital heart disease is an abnormality in the heart’s structure which exists from birth.  An individual is born with a defect and this may present at different points in one’s lifetime. It is often diagnosed in childhood. Some congenital heart defects cause no signs or symptoms. For some people, signs or symptoms occur later in life. In others, symptoms can return years after treatment of the heart defect.

Common congenital heart disease symptoms in adults include:

• Palpitations due to abnormal heart rhythms (arrhythmias)
• A bluish tint to the skin, lips and fingernails (cyanosis)
• Shortness of breath (dyspnoea), usually on exertion
• Fatigue and tiredness
• Swelling of legs (oedema) and abdomen (ascites)
• Change in the nails of both hands and feet with a drumstick appearance (clubbing)