What is the science behind congenital heart disease

Heart disease | Doctors and information

General symptoms of heart disease

While blood pressure that is too high can often only be detected by measuring the blood pressure, specific symptoms occur with many heart diseases that usually make patients see a doctor on their own. The most common side effects of heart disease are chest pain, which can radiate into the back or arms, rapid heartbeat, tightness of the chest ("angina pectoris"), shortness of breath during exertion, loss of performance with tiredness and weakness as well as serious cardiac arrhythmias. These symptoms are often indicative of heart disease, but the list of possible heart conditions is long. Some heart diseases are also acutely life-threatening and require emergency medical treatment. These include, above all, heart attacks and cardiogenic shock.

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High blood pressure can damage the heart or be a result of heart disease

High blood pressure (hypertension) does not hurt and is otherwise very difficult to notice. High blood pressure is usually a classic chance diagnosis as part of a medical examination. Constantly increased pressure in the blood vessels can, however, damage the vessel walls or lead to heart disease. If the coronary arteries are disturbed, there is a risk of a heart attack. A person suffers high blood pressure, the heart fights against a very high resistance in the vessels when it expels blood. As a result, the heart muscle has to work more and more in order to be able to maintain the same pumping capacity. More work, in turn, means that muscle mass, especially in the left ventricle, increases. The heart enlarges due to the increase in muscle, but at the same time the oxygen supply to the muscle cells suffers from this enlargement. The heart can become “tired”, the result is cardiac insufficiency (cardiac insufficiency).

On the other hand, high blood pressure is also the result of vascular and heart diseases, for example in that the pressure in the vessels increases in the course of vasoconstriction (arteriosclerosis).

Functional heart diseases (heart neuroses)

Functional heart diseases are often not organic heart diseases at all. The psyche very often plays a major role in this. Symptoms of functional heart disease are, for example, palpitations, chest pain, shortness of breath and tightness in the chest. The associated fears, which can increase to the point of death, gave these cardiac symptoms the name "cardiac neurosis". In about 15 percent of patients with heart disease, the symptoms cannot be explained organically. Nevertheless, in the case of breathlessness, palpitations and fear of death, organic heart diseases should always be ruled out by a doctor before functional heart problems can be spoken of.

Are functional Heart disease have been found, common heart drugs such. B. Beta blockers and sedatives are often ineffective or aggravate the symptoms. Heart neuroses are caused by mental imbalance and states of restlessness and, on the other hand, respond very well to conversation and relaxation procedures.

Heart disease of the inner skin (endocardial disease, endocarditis)

The inner lining of the heart (the endocardium) is a very thin epithelial layer that lines the heart inside. The heart valves also emerge from the inner lining of the heart. The inner lining of the heart can be colonized with bacteria due to mostly bacterial infections after operations or colds that have been dragged on. A very common cause of heart disease of the inner lining of the heart is rheumatic fever, which occurs as a result of a streptococcal infection in childhood. The resulting inflammation leads to endocardial defects (e.g. scarring) and can also impair the function of the heart valves. Heart diseases with endocardial involvement are therefore not uncommon Valvular heart disease after yourself. The symptoms of heart disease of the inner lining of the heart can be very dramatic and range from chills and high fever to anemia and heart failure to the risk of embolism. Embolism occurs when blood clots form in the small vessels in the body. After detachment of such a blood clot, this can, for. B. migrate into the brain and close smaller capillaries there. A stroke is the result.

Heart disease of the valves

Heart valve defects can be congenital heart diseases or heart diseases that develop in the course of a lifetime as a result of an infection in the lining of the heart. The inflammation of the inner lining of the heart (pericarditis) initially heals with scarring. If this happens to the heart valves, they can shrink, warp or even partially grow together. As a result, the function of such heart valves is restricted. Heart valve defects can occur as a stenosis or as an insufficiency. But how do these two types of heart disease differ?

With valve insufficiency, the heart valves close insufficiently. With each heartbeat, the blood continues to be pushed out through the affected valve, but then flows back into the chamber because the heart valve does not close completely. This so-called pendulum blood causes a flow noise that the doctor can hear with the help of a stethoscope.

Valve stenosis, on the other hand, prevents the affected heart valve from opening fully. As a result, the passage opening for the blood is narrowed, which means that less blood can be expelled with each heartbeat. The blood accumulates in the heart in front of the valve. This blood congestion can continue in the long term and, depending on the heart valve affected, lead to further heart diseases, e.g. B. lead to congested veins or pulmonary edema.

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Diseases of the pericardium (pericardial diseases, pericarditis)

Heart diseases with involvement of the pericardium often arise as a result of infections with bacteria, fungi or viruses or through infections in neighboring organs such as the lungs. Heart attacks, tumors in the chest and open heart operations can also lead to pericardial diseases. In the case of heart diseases, a distinction is essentially made between acute pericarditis and chronic pericardial inflammation. Both forms are characterized by severe pain behind the sternum and difficulty breathing. The cause of these two main symptoms of heart diseases with pericardial involvement is the occurrence of so-called dry or moist pericardial inflammation.

While on top of this Heart disease often the dry inflammation occurs, this turns into the wet inflammation in the further course. In dry pericardial inflammation, the two epithelial surfaces of the pericardium (inner and outer pericardial sheet) rub dry against each other. This causes the severe pain as well as the rubbing noises that resemble leather creaking. With moist pericardial inflammation, a fluid-filled space, a so-called effusion, is created between the two pericardial leaves. The heartbeat increases to counteract the pressure and at the same time there is increasing difficulty in breathing, as the effusion also restricts the space for the lungs to expand when breathing.

If left untreated, pericardial inflammation leads to manifest heart diseases, such as cardiac insufficiency, with massive restrictions in heart function and the formation of edema throughout the body, as the blood flow to the heart is increasingly restricted.

Heart muscle diseases (myopathies, myocarditis)

Inflammation of the heart muscle (myocarditis) is one of the life-threatening heart diseases, as the inflammation can lead to functional impairment of the heart and cardiac arrhythmias. Bacterial or viral infections are very common triggers for myocarditis. In rare cases, however, drugs (e.g. penicillin) and allergies can also trigger these heart diseases. Symptoms of myocarditis include shortness of breath, chest pain, rapid pulse, and extrasystoles (abnormal heart rhythms).

Cardiogenic shock is a rare complication of myocarditis. This is the result of an impending pump failure of the heart. Due to the inflammation of the heart muscle, the heart is no longer able to pump a sufficient amount of blood into the body. The person is anxious and suffers from an acute lack of oxygen due to insufficient blood flow. Cardiogenic shock is an emergency heart disease. The person concerned must be positioned with the upper body elevated until the emergency doctor arrives. Cardiogenic shock is characterized by gradual marbling of the skin on the neck, extremities and chest.

Heart disease with rhythm disturbances (arrhythmias)

Heart diseases with disorders of the heart rhythm can be divided into three large groups: palpitations (> 100 beats per minute), slow heartbeat (<60 beats per minute) and extra heartbeats (extrasystoles). Such disorders are usually caused by conduction disorders or problems with the generation of excitation for the heartbeat. But metabolic physiological processes such as an overactive thyroid can also justify cardiac arrhythmias.

Are dangerous Cardiac arrhythmias whenever the heart's pumping capacity is severely restricted as a result. Heart rates above 160 or below 40 beats per minute lead to a noticeable reduction in the amount of blood expelled. As a result, the brain lacks oxygen, which can lead to dizziness, impaired vision and loss of consciousness.

Atrial flutter (220 to 350 beats per minute) and atrial fibrillation (350 to 600 beats per minute), which lead to complete ventricular arrhythmias, which are life-threatening, can occur in the presence of severe heart disease and heart attacks.

Coronary artery disease - heart attack

Coronary artery disease is a complex of various heart diseases that together cost the life of around one in five people. The diseases include atherosclerosis of the coronary arteries of the heart, angina pectoris, myocardial infarction, as well as cardiac arrhythmias and cardiac insufficiency. The main risk factors for these heart diseases are smoking, high blood pressure, high blood lipid levels, diabetes, being very overweight, lack of exercise and increasing age.

In angina pectoris, there is already a very advanced narrowing (arteriosclerosis) of the vessels that supply the heart muscle (coronary arteries). Particularly under stress (e.g. climbing stairs, walking quickly), the blood flow capacity of the blood vessels is no longer sufficient to supply the heart muscle with sufficient oxygen. As a result, parts of the heart muscle are no longer supplied with blood for three to 20 minutes. The heart muscle reacts to this with pain that is felt as "tightness in the chest" with aching heart and shortness of breath. A rest period and nitroglycerine spray provide rapid symptom relief. When the heart rate falls during the break, the blood flow in the narrowed vessels is sufficient to meet the muscle’s need for oxygen again. Angina pectoris attacks are in any case a harbinger of an impending heart attack, so that constant medical monitoring is necessary.

In contrast to angina pectoris, a heart attack leads to irreversible tissue destruction in the heart muscle. Usually a branch of the coronary arteries is completely closed so that the supplied area is no longer supplied with blood; Heart muscle cells die. The symptoms are not that different from an angina pectoris attack, but usually last for more than 30 minutes. The pain of a heart attack is traditionally felt in the left chest area radiating into the left arm. In women, however, a heart attack very often manifests itself as pain in the upper abdomen and is therefore too often not recognized. The heart attack is a life-threatening emergency and requires immediate emergency medical attention.

Heart failure (heart failure)

Heart failure (heart failure) is one of the heart diseases in which the heart does not perform well; less and less blood is expelled into the circulation. The causes of heart failure are very numerous and can range from valve defects to arrhythmias to heart attacks. A distinction is made between left heart failure and right heart failure.

Left ventricular failure affects the left half of the heart and there is a backlog of blood in front of the left heart. As a result of this blood filling, the blood backs up into the lungs and pulmonary hypertension and edema formations occur. Key symptoms of left heart failure are therefore, among other things, shortness of breath, cardiac asthma, pulmonary edema, lack of oxygen in the body and rapid breathing rate.

Right heart failure usually arises as a result of previous left heart failure. The backflow of blood continues through the lungs to the right heart and leads to the full picture of "blocked" right heart failure. Typical of these heart diseases are congestion of the neck veins, congestion of the large hollow organs (liver, spleen, kidneys), weight gain, edema formation and increased nocturnal urination.

Congenital heart defects

Congenital heart diseases include all prenatal valve and septal defects as well as vascular disorders of the heart. Congenital heart disease occurs in about one percent of newborns.

In the case of atrial septal defect, the septum between the right and left atria in the heart is not closed. The excess pressure in the left atrium causes oxygen-rich blood to enter the right atrium. A naturally occurring atrial septal defect is the botallic duct, which all unborn children have. It fulfills the task of a short-circuit defect in order to bypass the not yet functional lung. Thus, the ductus botalli does not belong to the heart diseases in the neonatal environment.

The second most common defect in congenital heart diseases is the ventricular septal defect. The partition between the right and left ventricle is not closed, so that blood presses from the left ventricle into the right ventricle. The symptoms depend on the size of the defect and can range from oxygen deficiency symptoms to shortness of breath.

Further congenital heart disease mostly affect the large blood vessels leaving the heart. The origin of the aorta and pulmonary artery may be reversed, a condition that leads to deoxygenated blood in the body and is incompatible with life. Constrictions (stenoses) can also occur in the area of ​​the lung valves or the aortic arch. In the so-called fallottetralogy, four heart diseases occur at the same time, a ventricular septal defect, heart valve stenosis of the pulmonary valve, an enlargement of the right heart and aortic anomalies.

The more severe the heart defect, the more likely only heart surgery can help.