INTRODUCTION The UK has one of the highest rates of death from heart disease in the world one British

adult dies from the disease every three minutes - and stroke is the country's third biggest killer, claiming 70,000 lives each year. Heart attacks occur when blood flow is blocked, often by a blood clot, while strokes are caused either by blocked or burst blood vessels in the brain. A range of other conditions, including heart failure, when blood is not pumped properly around the body, and congenital heart defects can also cause long term problems, and even death, for sufferers.

HEART DISEASE The heart pumps blood around the body carrying oxygen and other nutrients to the areas that need it. When this process is interrupted, or does not work properly, serious illness and even death can result. The risk of heart disease is greater for people with poor diet, who smoke and do not exercise, and men are more likely to suffer from it than women. A range of tests and treatments, including drugs, heart bypass surgery and transplants, exist to alleviate symptoms or save the lives of sufferers.

HEART CONDITIONS

CAUSES, TESTS & TREATMENTS

RISK FACTORS & PREVENTION DIAGNOSTIC TESTS TREATMENTS - Drugs - Operations - Rehabilitation

HEART ATTACK HEART FAILURE ANGINA HARDENED ARTERIES HIGH BLOOD PRESSURE DISTURBED HEART RHYTHM HEART MUSCLE DISEASE HEART VALVE DISEASE CONGENITAL HEART DEFECTS

High blood pressure

Regular blood pressure checks are recommended

High blood pressure, or hypertension, increases the risk of heart attacks, strokes, kidney failure, damage to the eyes, congestive heart failure and atherosclerosis. It causes the heart to work harder than normal putting both the heart and arteries at

greater risk of damage. There are no external signs of high blood pressure, leading many people to have it for years without noticing. When combined with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke is several times higher. If high blood pressure isn't treated, the heart may have to work harder and harder to pump enough blood and oxygen to the body's organs and tissues to meet their needs. Causes Diabetes and diet, particularly salt, are key causes of hypertension. The risk of high blood pressure for black people is around three times that faced by white people. Use of oestrogen-based contraceptive pills and hormone replacement therapy has been implicated as a cause. When it is forced to work harder than normal for an extended time, the heart enlarges and weakens. While a slightly enlarged heart may work well, one that is significantly enlarged has a hard time meeting the demands put on it. Arteries also suffer the effects of high blood pressure, becoming scarred, hardened and less elastic. Though this hardening of the arteries often occurs with age, high blood pressure accelerates the process. The hardened or narrowed arteries are unable to supply the amount of blood the body's organs need, preventing them working effectively. Blood clot Another risk is that a blood clot may lodge in an artery narrowed by atherosclerosis, blocking blood supply. Hypertension exists where the pressure at which blood is pushing against blood vessel walls is consistently above average. It is measured in millimetres of mercury (mm Hg) and is defined in an adult as a blood pressure equal to or above 140mm Hg when the heart is contracting - systolic - and 90mm Hg when the heart is relaxing - diastolic.

Untreated high blood pressure can cause the heart to become abnormally large and less efficient - ventricular hypertrophy, causing heart failure and increased risk of heart attack. In 90 to 95% of cases, the cause is unknown. In the remaining cases, high blood pressure is a symptom of a recognisable underlying problem such as a kidney abnormality, tumour of the adrenal gland or congenital defect of the aorta.

High blood pressure definition Blood pressure at or above 140mm Hg when the heart is contracting - systolic Blood pressure at or above 90mm Hg when the heart is relaxing diastolic

When the root cause is corrected, blood pressure usually returns to normal. This type of high blood pressure is called secondary hypertension. The only way to find out if you have high blood pressure is to have your blood pressure checked. A doctor or other qualified health professional should check a patient's blood pressure at least once every two years. The condition can be effectively controlled using drugs - usually ACE inhibitors or betablockers.

Angina

Chest pain is the key symptom of angina

Angina - a feeling of pain, heaviness, tightness, burning or squeezing in the chest - is an indication that the sufferer has heart disease and is at risk of a heart attack. It occurs when the heart muscle does not receive enough oxygen due to a narrowing of one of the arteries that supply blood to the heart. The pain can spread to the arms, neck, jaw, face back or stomach. In some people it is a dull, persistent ache. Dr Tony Gershlick, consultant cardiologist and honorary senior lecturer at University Hospitals Leicester, said: "Angina is very debilitating and can effect your quality of life and the amount of exercise you can do and can impact on your diagnosis in terms of morbidity and mortality."

The condition is usually brought on by physical exertion, emotional stress or extreme temperatures when the demand for oxygen from the heart is greater then the blood supply available. A patient may go for a walk and the limited blood supply from hardened arteries means that the increased blood supply needed does not reach the heart causing cramp, or angina. Morbidity risk The condition is associated with higher risk of morbidity in patients. Changes to smoking, eating and other lifestyle factors can have a beneficial effect. Variant angina pectoris, or Prinzmetal's angina, however, can occur when a person is at rest. It occurs as a result of coronary artery spasm and may occur frequently for six months or more. People who develop heart rhythm disturbances at this time are at risk from sudden death, but survival rates for those who survive a heart attack during this period are very good. Treatment comes in the form of drugs in the first instance, but if the condition is too severe then procedures such as angioplasties may be needed to correct the narrowing of the artery walls.