Heart

Overview

Your heart is a strong muscle about the size of your closed fist. It sits in the middle of your chest, slightly to the left, and works all day and night pumping blood around your body. Blood carries oxygen and nutrients to every part of you, and carries waste away. When doctors talk about 'heart problems' or 'heart disease', they mean a group of conditions that affect the heart muscle, the valves inside it, its electrical wiring, or the blood vessels that feed it. Some heart conditions are present from birth. Many others develop slowly over years, often without any warning signs at first. The good news is that a lot of heart trouble can be prevented, and most heart conditions can be treated well.

Yes. Heart and circulation (cardiovascular) problems are among the most common health issues worldwide and one of the leading causes of ill health in many countries, including the UK. Almost everyone knows someone affected. Because they are so common, there is a lot of research behind how to prevent and treat them.

Heart conditions can affect anyone, at any age, including babies and children. However, risk generally rises as you get older. Risk is also higher if you smoke, have high blood pressure, high cholesterol or diabetes, carry extra weight around your middle, or have a close relative who had heart problems at a young age. Some communities, including people of South Asian heritage, have a higher risk. Men tend to develop heart disease earlier than women, but heart disease is a leading cause of death in women too, and women's symptoms can be different.

Symptoms

Common symptoms

• Chest pain, tightness, heaviness or pressure — often described as a squeezing or band-like feeling
• Feeling short of breath, especially when active, lying flat, or climbing stairs
• Unusual tiredness or low energy during everyday activities
• A fluttering, pounding or racing feeling in the chest (palpitations)
• Dizziness, light-headedness or feeling faint
• Swelling in the ankles, feet or legs
• Discomfort in the arm, jaw, neck, back or stomach without an obvious cause

Symptoms in children

• Most heart problems in children are present from birth (called congenital heart conditions)
• Bluish or grey tinge to the lips, tongue or fingernails
• Getting tired or sweaty very quickly during feeding or play
• Poor weight gain or slow growth
• Fast breathing, or breathing heavily when feeding
• Fainting or collapsing during exercise (this needs urgent medical attention)
• Some children have no visible signs at all, and a heart murmur is first noticed at a routine check

Symptoms in older adults

• Getting breathless doing things that used to feel easy, such as walking to the shops
• Waking up at night feeling breathless, or needing extra pillows to sleep comfortably
• Swelling in the legs and ankles, or shoes feeling tight
• Feeling unusually tired, weak or 'not myself'
• Confusion or a change in thinking, which can sometimes be the main sign of a heart problem in older adults
• Falls or dizziness when standing up
• Indigestion-like discomfort or a vague 'full' feeling in the chest

Causes

Main causes

• Coronary heart disease — the arteries (blood vessels) that feed the heart muscle become narrowed by fatty deposits called plaque
• High blood pressure — this puts extra strain on the heart and blood vessels over time
• Heart rhythm problems (arrhythmias) — the heart's electrical signals become too fast, too slow or irregular
• Heart valve problems — valves that should open and close neatly become narrowed or leaky
• Heart muscle weakness or damage (sometimes called heart failure when the heart can't pump as strongly as it should)
• Conditions present from birth (congenital heart conditions)
• Infections or inflammation affecting the heart muscle or its lining
• Problems with the heart's structure caused by other long-term illnesses, such as kidney disease or thyroid problems

Risk factors

• Smoking or vaping nicotine — one of the biggest risk factors, and one of the most rewarding to change
• High blood pressure
• High cholesterol
• Type 2 diabetes, or pre-diabetes
• Carrying extra weight, especially around the waist
• Not being physically active
• A diet high in salt, saturated fat and processed foods, and low in vegetables, fruit and fibre
• Drinking too much alcohol
• A family history of heart disease at a young age (for example, a parent or sibling affected before 60)
• Age — risk rises with time, and being male carries extra risk
• Ethnic background — people of South Asian heritage have a higher risk
• Sleep problems, including snoring and sleep apnoea (pauses in breathing during sleep)
• Long-term stress and poor mental health
• Kidney disease and some other long-term conditions

When to see a doctor

See a doctor urgently if:

• Any chest pain or pressure that is new, severe, or that comes and goes
• Breathlessness that is new or getting worse quickly
• Palpitations that don't settle, or that come with dizziness
• Fainting or near-fainting, especially during activity
• Sudden swelling in the legs or ankles
• Coughing up pink, frothy spit

Book a routine appointment if:

• A close family member has heart disease or died from it at a young age
• You've been told your blood pressure or cholesterol is high
• You feel more tired or breathless than usual during everyday activity
• You have diabetes, kidney disease or another long-term condition
• You want a general heart health check or advice on lowering your risk
• You have a heart murmur or have been told your heart sounds unusual

Diagnosis

A doctor usually starts by asking about your symptoms, your lifestyle, your family history and any medicines you take. They will examine you, listening to your heart with a stethoscope and checking your blood pressure, pulse and ankles. From there, they may arrange simple tests in the clinic, and refer you to a heart specialist (cardiologist) if more detailed tests are needed. Most heart tests are painless and quick.

Tests that may be done

• Blood tests — to check cholesterol, blood sugar, kidney function, and markers released when heart muscle is under strain
• An ECG (electrocardiogram) — sticky pads on your chest record the heart's electrical rhythm in a few minutes
• A Holter or ambulatory monitor — a small portable ECG you wear for a day or more to catch irregular rhythms
• Echocardiogram — an ultrasound scan of the heart that shows its size, pumping strength and valves
• An exercise or stress test — measuring your heart while you walk or cycle on a machine
• A CT coronary angiogram — a detailed scan that shows whether the heart arteries are narrowed
• A coronary angiogram — a thin tube is guided to the heart to look at the arteries directly; this is also used to place a stent if needed
• Blood pressure monitoring — either in clinic or with a cuff you wear at home for 24 hours
• An MRI or other scans, used for specific heart muscle conditions

What to expect at your appointment

You will usually hear the results of simple tests quite quickly. Some tests need a follow-up appointment, which can take a few weeks. It's a good idea to bring a list of your medicines, and to write down your questions beforehand. If you feel anxious about tests, tell the team — they are used to this and can explain each step.

Treatment

Treatment for heart conditions usually combines three things: changes to your everyday habits, medicines when they are needed, and sometimes a procedure or operation. The exact mix depends on which heart condition you have and how much it affects you. Many people find that treatment makes a big difference to how they feel within weeks.

Self-care at home

• If you smoke, stopping is the single most powerful thing you can do for your heart — ask your doctor or pharmacist how to get support
• Move more, in whatever way suits you — walking, swimming, gardening or dancing all count
• Eat more vegetables, fruit, wholegrains, beans and fish, and cut down on salt and heavily processed foods
• Keep alcohol within the recommended limits, and try to have several alcohol-free days each week
• Aim for enough sleep, and get help if you snore heavily or feel exhausted in the mornings
• Keep an eye on your blood pressure and cholesterol numbers, and know what your targets are
• Take any prescribed medicines regularly — if side effects bother you, talk to your doctor rather than stopping
• Tell your doctor or pharmacist before starting any new supplement or over-the-counter remedy, as some interact with heart medicines

Medical treatments

Doctors use several groups of medicines for heart conditions. Some lower blood pressure, some lower cholesterol, some make the blood less likely to clot, some control the heart's rhythm, and some help the body get rid of extra fluid. Your doctor will explain why a particular medicine is suggested, what it is for, and what to watch out for. Never start, stop or change a heart medicine on your own — always ask your doctor or pharmacist first. If cost or side effects are a problem, say so; there is often another option.

When is surgery considered?

Some heart problems are best treated with a procedure. These include stretching a narrowed artery open and holding it with a small mesh tube (a stent), bypass surgery to reroute blood around a blocked artery, repairing or replacing a faulty valve, fitting a pacemaker or an implantable device to steady the heartbeat, or a procedure to correct an irregular rhythm. Your specialist team will explain the benefits and risks and help you decide what is right for you.

Living with this condition

Most people with a heart condition live full, active lives. The key is to build a routine that works for you: take your medicines at the same time each day, keep gentle activity regular rather than occasional, and notice how your body responds. Many people find it helpful to check their weight or blood pressure at home, and to keep a simple diary of symptoms to share at appointments. Pacing yourself and planning rest breaks is not a sign of weakness — it's good management.

Lifestyle tips

• Build activity into your day: a short walk after meals, taking the stairs, or a regular class with a friend
• Ask your doctor or a cardiac rehabilitation team about a supervised exercise programme — these are proven to help people feel better and safer
• Keep your home warm in cold weather, as cold can strain the heart
• Avoid sudden heavy lifting or straining if your doctor has advised against it
• Cut back on caffeine and energy drinks if they trigger palpitations
• Stay up to date with routine health checks and vaccinations
• Plan ahead for travel and holidays — carry a list of your medicines and enough supply

Diet and exercise

A heart-friendly way of eating doesn't mean giving up enjoyment. Try to fill most of your plate with vegetables, fruit, wholegrains, beans, lentils and nuts. Choose fish twice a week, including oily fish, and use olive or rapeseed oil instead of butter where you can. Cut down on salt — most of it hides in bread, sauces and processed foods rather than the salt cellar. Keep sugary drinks and sweets as occasional treats. For activity, aim for something most days; even 10 minutes at a time adds up. A mix of walking or cycling and some light strength work (carrying shopping, chair-based exercises) is a good goal. Always build up gradually, and if you get chest pain, severe breathlessness or dizziness during activity, stop and seek medical advice.

Mental health and emotional wellbeing

Being told you have a heart condition can bring worry, low mood or fear, and it's very common to feel anxious about everyday activities afterwards. This is understandable, and it usually eases with time, information and support. Talking to friends, family, your GP or a counsellor can help a great deal, and some people find relaxation, breathing exercises or gentle activity helpful for anxiety. If you feel persistently low, hopeless, or are having thoughts of harming yourself, please reach out right away: contact your local emergency number or a crisis line in your country, or speak to your doctor. You are not alone, and help is available.

Prevention

Largely, yes. Most heart and circulation disease is linked to things you can change. Stopping smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well, limiting alcohol and managing stress can greatly lower your risk — even if you start later in life. Nobody manages all of this perfectly, and small, steady steps count for more than a perfect plan you can't keep up.

Vaccines

Some vaccinations are recommended for people with heart conditions, because infections like flu and respiratory viruses can put extra strain on the heart. Ask your GP, nurse or pharmacist which vaccinations are advised for you and when. Keep other routine vaccinations up to date as well.

Screening programmes

Regular checks can catch heart problems early. In the UK, the NHS Health Check is offered every five years to adults aged 40 to 74 and includes blood pressure and cholesterol testing. Blood pressure checks are also widely available at pharmacies and GP surgeries. If you have diabetes or kidney disease you'll be offered regular heart risk reviews. Ask your doctor what checks are right for you, especially if heart disease runs in your family.

Complications

If left untreated

• Heart attack — when blood flow to part of the heart muscle is blocked
• Heart failure — the heart becomes too weak or stiff to pump efficiently, causing breathlessness and swelling
• Dangerous heart rhythms, which can cause collapse
• Stroke, which shares many of the same risk factors as heart disease
• Kidney damage, because the heart and kidneys depend on each other
• Reduced quality of life, with tiredness and breathlessness limiting everyday activities

Long-term outlook

The outlook for people with heart conditions has improved enormously over recent decades. Many people live long, full and active lives with the right treatment and support. Catching problems early makes a real difference, so keep up with checks and don't dismiss new symptoms. There is a lot you can do to steer your own health, and your healthcare team is there to help at every step.

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