Heart disease is one of the leading causes of deaths worldwide. According to the Singapore Heart Foundation, 21 people die from cardiovascular or heart disease every day [1].
What is heart disease?
The heart is only the size of your fist but is one of the most important organs of our body. It is part of the circulatory system which also comprises the veins, arteries, and capillaries. The circulatory system is responsible for carrying blood to and from the whole body.
The heart is made up of many layers of muscle and electrical signals that help keep it pumping and thus keeping us alive. This intricate balance and co-existence of muscle layers and electrical signals work to ensure that our heart beats without problem, however, if there is a slightest change or damage to either one of these, the heart and its rhythm will be negatively impacted, resulting in a heart condition or disease.
Heart disease is the umbrella term for a plethora of heart conditions. Each type of heart condition has its own range of symptoms, causes, and treatment. In this ultimate guide, we will talk about the different types of heart conditions, what their causes and symptoms are, and what sort of treatment is available.
Types of heart disease/conditions include:
- Arrhythmia: also known as abnormal heart rhythms or irregular heartbeats.
- Coronary artery disease (CAD): also known as coronary heart disease and is the most common type of heart disease worldwide.
- Cardiomyopathy: hardened or weakened heart muscles.
- Congenital heart defects: heart problems that are present at birth.
- Heart attack: also known as myocardial infarction and is one of the causes of heart failure.
- Cardiac arrest: sudden stop of blood flow from the heart.
- Hypertensive heart disease: heart problems related to high blood pressure.
Before we learn more about the types of heart diseases, we must know more about the structures of the heart and how they function. Our heart is made up of four chambers, two on top and two below. The chambers at the top are known as the atria while the chambers below are known as the ventricles. Within our heart are heart valves that help blood flow in the correct direction and prevent the backflow of blood.
Arrhythmia
Arrhythmia, also known as abnormal heart rhythms or irregular heartbeats, occurs when the electrical signals that help maintain a normal heartbeat, do not work as they should. This causes the heart to either beat too quickly (tachycardia) or too slowly (bradycardia).
Individuals with heart arrhythmia describe feeling a fluttering or skipped heartbeats, these may either be harmless or life-threatening. Types of heart arrhythmia include:
- Tachycardia: heart beats faster than normal and is characterised by a heartbeat of more than 100 beats per minute.
- Bradycardia: heart beats slower than normal and is characterised by a heartbeat of less than 60 beats per minute.
There are certain conditions, where having a slow or fast heartbeat is completely normal. For example, it is normal for your heart to beat faster when you are exercising or if you are excited. It is also normal to have a slow heartbeat if you are an athlete or if you are asleep.
There are five types of tachycardia, these are:
- Atrial fibrillation: chaotic or messy electrical signals resulting in an uncoordinated and fast heart rate. Some episodes of atrial fibrillation may be temporary and go away without any intervention while others may require medical treatment before it stops. Atrial fibrillations are also associated with strokes.
- Atrial flutter: similar to an atrial fibrillation but is less chaotic. Like atrial fibrillations, atrial flutters are also associated with strokes.
- Supraventricular tachycardia: arrhythmias that start in the ventricles and causes sudden heart palpitations that end unexpectedly.
- Ventricular fibrillation: a serious condition that can lead to death. It occurs when messy electrical signals cause the ventricles to shiver instead of contract, this means that the heart is unable to beat properly, and blood is not transported to the rest of the body.
- Ventricular tachycardia: electrical signals incorrectly overstimulate the ventricles to contract too quickly. This means that the ventricles are not able to fill completely with blood before contracting.
There are two types of bradycardia, these are:
- Sick sinus syndrome: the rhythm of our heart is controlled by electrical signals sent out by the sinus node. The sinus node is a group of specialised cells situated in the right atrium or right upper heart chamber. Sick sinus syndrome occurs when the sinus node malfunctions causing the heart to alternate between slow and fast heart rates.
- Conduction block: occurs when there is a blockage of the electrical signals resulting in a drop, skip, or complete stoppage of heart beats.
What are the symptoms of arrhythmia?
In general, individuals with heart arrhythmia may experience the following symptoms:
- Heart palpitations
- Fast heartbeat
- Slow heartbeat
- Breathlessness
- Chest pains
What are the causes of arrhythmia?
We already know that arrhythmias occur when the electrical signalling of the heart is faulty, resulting in an uncoordinated and messy heart rhythm. Let’s look at what causes the electrical signals to become faulty in the first place. The causes of arrhythmia are:
- Heart attack
- Scar tissue from previous heart attack
- Coronary artery disease or ischaemic heart disease
- High blood pressure
- Diabetes
- Hyperthyroidism
- Hypothyroidism
- Obstructive sleep apnoea
- Genetics
- Smoking
- Covid-19 infection
- Reaction to medications
- Drug abuse
- Excessive consumption of alcohol or caffeine
The above causes are also factors that may increase your risk of heart arrhythmias.
Coronary artery disease (CAD)
Coronary artery disease also known as coronary heart disease or ischaemic heart disease, is the most common type of heart condition worldwide. According to research published in 2022, 610,000 deaths annually are due to coronary artery disease, this accounts for 1 in 4 deaths [2].
Coronary artery disease occurs when the blood vessels connected to the heart become blocked or narrowed. This results in reduced blood, oxygen, and nutrients being sent to the heart. Coronary artery disease occurs over a long period of time and symptoms will only start to show when a significant amount of the blood vessel is blocked. This blockage of the blood vessel is known as atherosclerosis and occurs due to a build-up of cholesterol deposits or plaques.
If the blood vessel is partially blocked, you may experience angina or chest pains, but if the blood vessel is completely blocked, it can cause a heart attack or myocardial infarction.
There are two types of coronary artery disease, these are:
- Stable ischaemic heart disease: a chronic or long-term coronary artery disease. It is associated with the long-term build-up of plaque in the blood vessels causing them to narrow and become blocked. You may experience some symptoms, but you will still be able to go about your daily routine.
- Acute coronary syndrome: the build-up of plaque in your blood vessel suddenly bursts or ruptures. This signals the formation of a blood clot to repair the rupture, resulting in a complete blockage of the blood vessel, and eventually leading to a heart attack.
Coronary artery disease is often known as the “silent killer” because it can lead to various life-threatening complications such as:
- Angina: also known as chest pains. Narrowed blood vessels mean that the heart is not getting a sufficient amount of blood, this can result in chest pains and breathlessness especially during strenuous activities like exercise.
- Heart attack: occurs when the plaque ruptures, causing blood clots to form in an attempt to repair it. This completely blocks off the blood vessel resulting in no blood flow to the heart, and thus damaging heart muscle.
- Heart failure: caused by weakened or damaged heart muscles. This occurs when the heart does not get enough blood flow and overtime, the heart muscles get damaged or weakened, making it more difficult for the heart to pump normally.
- Arrhythmia: reduced blood flow can disrupt the normal electrical signal resulting in arrhythmias.
What are the symptoms of coronary artery disease?
Individuals with coronary artery disease may experience the following symptoms:
- Angina or chest pains
- Breathlessness
- Heart attack
- Fatigue or exhaustion
What are the causes of coronary artery disease?
Coronary artery disease occurs when there is a build-up of plaque along the blood vessels of the heart. The following are what causes this build-up of plaque to occur:
- High cholesterol
- Diabetes or insulin resistance
- Sedentary lifestyle or a lack of exercise
- Smoking
Who is at risk of coronary artery disease in Singapore?
There are several factors that may increase your risk of coronary artery disease, these are:
- Age: your risk increases as you age because coronary artery disease usually occurs when plaque builds-up over a period of time.
- Gender: men are more likely than women to suffer from coronary artery disease.
- Family history: having a family member with a history of coronary artery disease increases your risk. This is especially true if your family member experienced it before the age of 55 for men and before the age of 65 for women.
- Smoking: smoking increases the risk of many diseases such as cancer, hypertension, coronary artery disease, etc.
- Diabetes: individuals with diabetes also tend to suffer from high blood pressure and obesity which are also risk factors for coronary artery disease.
- High cholesterol: having excess cholesterol in your body will cause them to be deposited in the blood vessels causing them to build-up over time. This results in narrowed or blocked blood vessels that eventually causes coronary artery disease.
- High blood pressure: this can cause your arteries to stiffen and become hard, eventually causing a narrowing of the blood vessel.
- Obesity or overweight: being obese or overweight increases your risk of coronary artery disease.
- Chronic kidney disease: individuals with chronic kidney disease have an increased risk of coronary artery disease.
- Sedentary lifestyle: individuals who do not exercise increase their risk of coronary artery disease and other medical conditions such as diabetes.
- Alcohol: excessive consumption of alcohol increases your risk of many diseases such as liver cirrhosis and coronary artery disease.
Cardiomyopathy
Cardiomyopathy is a condition that affects the myocardium which is the muscles of the heart. It is characterised by stiff, enlarged, or thickened heart muscles that may lead to the formation of scar tissues. This will affect the ability of the heart to beat normally and may eventually lead to heart failure.
There are various types of cardiomyopathies, these are:
- Dilated cardiomyopathy: the left ventricle is enlarged and unable to properly pump blood out of the heart.
- Hypertrophic cardiomyopathy: occurs when there is abnormal thickening of the heart muscle making it more difficult for the heart to pump normally.
- Restrictive cardiomyopathy: the heart muscles become stiff and weak, making it difficult for the heart to expand and fill with blood.
- Arrhythmogenic right ventricular dysplasia: the muscle of the right ventricle is replaced by scar tissue, thus leading to problems with heart rhythm.
What are the symptoms of cardiomyopathy?
Individuals with cardiomyopathy may experience the following symptoms:
- Exhaustion or fatigue
- Fainting or syncope
- Heart palpitations
- Breathlessness
- Swelling in the ankles, legs, or calves
What are the causes of cardiomyopathy?
Oftentimes, the cause of cardiomyopathy is unknown or in medical terms, idiopathic. However, some causes include:
- Genetics
- Damaged heart tissue
- Coronary artery disease
- Heart infections
Who is at risk of cardiomyopathy in Singapore?
Cardiomyopathy does not discriminate and can affect people of all ages, however, there are also several factors that may increase your risk, these are:
- Family history of cardiomyopathy
- Obesity/overweight
- Diabetes
- Heart valve disorders
- High blood pressure
- Coronary artery disease
- Sarcoidosis
- Hyperthyroidism
- Hypothyroidism
- Heart infections
- Long-term alcohol or drug abuse
- Pregnancy
Congenital heart defects
Congenital heart defects are heart conditions that were present at birth. There are many types of congenital heart defects, these are:
Atrial septal defect: also known as a hole in the heart. This hole usually occurs between the two upper chambers of heart or atria. Small holes usually close as the years go by, but larger holes require surgery to prevent further complications.
- Atrioventricular canal defect: characterised by a hole in the heart together with heart valve problems. These issues will cause extra blood to flow through the heart, making it beat too hard, resulting in the heart muscle growing too big.
- Bicuspid aortic valve: occurs when the aortic valve only has two cusp instead of the usual three. This may cause reduced or blocked blood flow to the heart, backflow of blood, or an enlarged aorta.
- Coarctation of the aorta: narrowing of the aorta, the main blood vessel of the heart.
- Congenital mitral valve anomalies: stiff or leaky mitral valve flaps that can reduce blood flow to the chambers of the heart or cause the backflow of blood.
- Double-outlet right ventricle: occurs when the two main blood vessels (aorta and pulmonary vein) that connect to the heart, do not connect at the correct places.
- Eisenmenger syndrome: abnormal blood flow in the heart and lungs.
- Ebstein anomaly: occurs when the tricuspid valve is not in the right position and not functioning properly.
- Hypoplastic left heart syndrome: underdeveloped left side of the heart.
- Long OT syndrome: also known as heart conduction/signally disorder, results in fast and out of control heartbeats.
- Patent ductus arteriosus: opening between the two major blood vessels which may cause blood to flow in the wrong direction, resulting in weakened heart muscles and heart failure.
- Pulmonary atresia: the valve that allows blood to flow from the heart to the lungs does not form correctly, this means that insufficient oxygen is being transported around the body.
- Pulmonary valve stenosis: narrowed valve between the chambers of the heart and lungs. This results in reduced blood flow through the valve.
- Tetralogy of fallot: caused by a combination of four congenital heart defects. It results in insufficient oxygen being transported from the heart to the rest of the body.
- Ventricular septal defect: similar to atrial septal defect but this time the hole occurs between the lower chambers of the heart or the ventricles.
- Wolff-Parkinson-White (WPW) syndrome: an extra electrical signalling pathway develops and causes rapid heartbeats.
What are the symptoms of congenital heart defects?
Individuals with congenital heart defects may experience the following symptoms:
- Heart arrhythmias
- Bluish tint to skin, nails, and lips
- Breathlessness
- Swelling of body tissue or organs
- Feeling tired easily during physical activity
What are the causes of congenital heart defects?
Most of the time, the cause of congenital heart defects is unknown or idiopathic. It is just something that goes wrong as the baby develops in the womb.
Who is at risk of congenital heart defects in Singapore?
While the main cause of congenital heart defects is unknown, there are several factors that may increase the risk, these are:
- Genetics: many congenital heart defects tend to be inherited and passed down through generations.
- Rubella: pregnant women who were exposed to rubella can affect the baby’s heart development.
- Diabetes: having diabetes during pregnancy can also affect the baby’s heart development.
- Medications: there is a reason why some medications are not safe to take during pregnancy, they may cause birth defects such as congenital heart defects.
- Alcohol and smoking: these have been linked to many birth defects including congenital heart defects.
Heart attack
Heart attacks, also known as myocardial infarction, are probably the most well-known heart condition. It occurs when blood flow to the heart is reduced or blocked due to narrowed blood vessels from the build-up of cholesterol deposits or plaques. It usually occurs as a result on complications from coronary artery disease.
What are the symptoms of a heart attack?
If you experience the following symptoms, you may be having a heart attack:
- Chest pain or angina: often feels like squeezing, pressure, or tightness in your chest. Individuals have described it as the feeling of someone sitting or standing on your chest.
- Pain or discomfort: pain or discomfort that starts in your chest and spreads to your shoulders, arms, back, neck, jaw, or teeth.
- Cold sweat: individuals tend to break out in a cold sweat when they are having a heart attack.
- Fatigue: the lack of blood flow and cause you to feel fatigue.
- Heartburn or indigestion: chest pains can also feel like heartburn or indigestion.
- Light headedness: lack of blood flow to the brain may cause you to feel lightheaded.
- Nausea: you may feel nauseated and may even vomit during a heart attack.
- Breathlessness: you may experience breathlessness as there is insufficient oxygen being transported around the body.
What are the causes of a heart attack?
There are many causes of a heart attack, these are:
- Coronary artery disease
- Coronary artery spasm
- Viral infections
- Spontaneous coronary artery dissection
Who is at risk of a heart attack in Singapore?
There are several factors that may increase your risk of a heart attack, these are:
- Age: your risk increases as you age because cholesterol deposits or plaque tend to build up over time.
- Smoking: smoking increases the risk of many diseases such as cancer, hypertension, coronary artery disease, heart attacks etc.
- Diabetes: individuals with diabetes also tend to suffer from high blood pressure and obesity which are also risk factors for heart attacks.
- High cholesterol or triglyceride levels: having excess cholesterol and triglycerides in your body will cause them to be deposited in the blood vessels causing them to build-up over time. This results in narrowed or blocked blood vessels that eventually causes heart attacks.
- High blood pressure: this can cause your arteries to stiffen and become hard, eventually causing a narrowing of the blood vessel.
- Obesity or overweight: being obese or overweight increases your risk of heart attacks.
- Chronic kidney disease: individuals with chronic kidney disease have an increased risk of coronary artery disease.
- Family history: you have an increased risk of heart attack if you have a family member who had a heart attack at an early age.
- Sedentary lifestyle: individuals who do not exercise increase their risk of heart attacks and other medical conditions such as diabetes.
- Alcohol: excessive consumption of alcohol increases your risk of many diseases such as liver cirrhosis and coronary artery disease.
- Autoimmune disorders: some autoimmune disorders such as lupus or rheumatoid arthritis can increase your risk of heart attacks.
Cardiac arrest
Cardiac arrest is the sudden and acute loss of blood flow to the heart. This results in loss of consciousness, breathing, and heart rate. Immediate medical attention is required because prolonged loss of blood to the brain and other organs can result in death.
Cardiac arrest usually occurs due to a malfunction of the electrical signal or rhythm of the heart. It is often confused with a heart attack which is caused by a blocked or narrowed blood vessel.
What are the symptoms of cardiac arrest?
Cardiac arrest is characterised by the following symptoms:
- Loss of consciousness
- No heart beat
- No breathing
There are also several symptoms that may occur before someone goes into cardiac arrest, these are:
- Rapid heart rate
- Chest discomfort
- Breathlessness
- Feeling weak
What are the causes of cardiac arrest?
The main cause of cardiac arrest is an arrythmia. As mentioned above, arrhythmia, also known as abnormal heart rhythms or irregular heartbeats, occurs when the electrical signals that help maintain a normal heartbeat, does not work as it should. This causes the heart to either beat too quickly (tachycardia) or too slowly (bradycardia).
Cardiac arrests are most frequently caused by atrial fibrillation which is a type of tachycardia. Atrial fibrillation is characterised by chaotic or messy electrical signals which result in an uncoordinated and fast heart rate. Some episodes of atrial fibrillation may be temporary and goes away without any intervention while others may require medical treatment before it stops. Atrial fibrillations are also associated with strokes.
In addition to arrythmias, there are also other causes of cardiac arrest such as:
- Intense physical activity
- Large blood loss
- Congenital heart defects
- Coronary heart disease
Who is at risk of cardiac arrest in Singapore?
There are several factors that increase your risk of cardiac arrest, these are:
- History of heart attack: your risk of a cardiac arrest increases in the first 6 months after a heart attack.
- Family history: if you have family members who experienced cardiac arrest, your risk increases.
- History of unexplained fainting: if you have fainted for unexplained reasons, your risk of cardiac arrest increases.
- Heart related diseases: having any of the heart diseases mentioned in this article, puts you at an increased risk of cardiac arrest.
- Blood changes: substantial changes in your blood’s concentration of potassium and magnesium can increase your risk of a cardiac arrest.
- Obesity: obesity increases your risk of various heart diseases which in turn increases your risk of a cardiac arrest.
Hypertensive heart disease
Hypertensive heart disease, as its name suggests, is related to hypertension or high blood pressure. Hypertensive heart disease is a chronic condition that occurs due to long-term unmanaged high blood pressure. Your heart is exposed to a large amount of stress if you have high blood pressure, making it difficult for it to pump blood. High blood pressure also causes your blood vessels to thicken and become narrow, thus restricting blood flow.
There are two types of hypertensive heart disease, these are:
- Coronary artery disease: occurs when the blood vessels connected to the heart become blocked or narrowed. This results in reduced blood, oxygen, and nutrients being sent to the heart.
- Left ventricular hypertrophy: the left ventricle of the heart pumps blood to the whole body. If someone has unmanaged, prolonged high blood pressure, the left ventricle will thicken, causing it to malfunction.
What are the symptoms of hypertensive heart disease?
If you experience the following symptoms, you may have hypertensive heart disease:
- Breathlessness
- Heart palpitations
- Dizziness
- Fainting
- Chest pain
What are the causes of hypertensive heart disease?
The main and only cause of hypertensive heart disease is years of uncontrolled high blood pressure or hypertension.
Who is at risk of hypertensive heart disease in Singapore?
Individuals with the following factors have an increased risk of hypertensive heart disease:
- High blood pressure
- Over the age of 45
- Sedentary lifestyle
- Lack of exercise
- Diabetes
- Overweight or obese
- Smoker
- Consumes alcohol
How are heart diseases diagnosed?
Heart diseases are diagnosed using one or more of the following diagnostic tools:
- Electrocardiogram (ECG): a non-invasive test that records the electrical signals of the heart.
- Holter monitoring: a portable ECG which can record the electrical signals of your heart throughout the day.
- Echocardiogram: a non-invasive examination that uses sound waves to create images of the heart. It shows how blood flows through the heart and is able to identify if there are any narrowed or leaking heart valves.
- Stress test: this test is able to observe how your heart responds to exercise by recording your heart activity while you walk or run on a treadmill.
- Cardiac computed tomography scan (CT-scan): a 3D x-ray is taken of your heart to identify any abnormalities.
- Cardiac magnetic resonance imaging (MRI): detailed imaging of your heart is taken to identify any abnormalities.
- Cardiac catheterisation: a thin and flexible tube is inserted through the groin or wrist and into a blood vessel of the heart. This checks for any blocked or narrowed blood vessels.
What are the treatment options for heart diseases in Singapore?
There are many types of treatment available for heart diseases, these are:
- Lifestyle changes: the first way to prevent or treat heart disease is to make positive lifestyle changes. These include eating healthy, exercising, quitting smoking, quitting drinking, and getting enough sleep.
- Medications: some heart diseases such as hypertensive heart disease and coronary artery disease can be treated using medications.
- Pacemaker: small devices that are inserted to keep your heart rhythm regular. They do so by sending electrical signals to your heart. Commonly used to treat arrythmias.
- Electrical cardioversion: electric shock to your chest to reset your heart rhythm.
- Implantable cardioverter defibrillator: essentially a defibrillator which is inserted to keep track of your heart rate and restore your heart rhythm using electric shock. Used to treat arrythmias.
- Surgery: some heart diseases such as coronary artery disease, can be treated using surgery such as angioplasty (a stent is inserted to unblock or widen a blood vessel), coronary artery bypass graft surgery (a healthy blood vessel is taken from another part of your body to bypass the damaged or diseased blood vessel).
Frequently asked questions
Can heart disease be prevented?
There are some risk factors that you can’t control such as your genetics, family history, and sex. But you can lower your risk of heart disease by controlling the other factors, here’s how:
- Maintain healthy blood pressure and cholesterol: these two factors significantly increase your risk of heart disease if they are uncontrolled and at unhealthy levels.
- Opt for a healthy lifestyle: having a clean diet and exercising regularly can help reduce your risk of heart disease. A healthy lifestyle can strengthen your heart and protect it from heart disease.
- Manage stress levels: try and manage your stress levels as much as possible because they have been linked to increase risk of heart disease.
Can heart disease be cured?
There is no cure for heart disease, but it can be managed long-term. Life-time monitoring, appropriate medications, and healthy lifestyle will go a long way in the management of your heart disease.
Can someone with heart disease drink alcohol?
Alcohol should be avoided in individuals with any type of heart disease.
How does physical activity reduce heart disease?
Physical activity reduces blood pressure and cholesterol. This in turn helps to lower the incidence of heart disease.
References
- Singapore Heart Foundation. (2022). Heart Disease Statistics. Retrieved from Singapore Heart Foundation:
https://www.myheart.org.sg/health/heart-disease-statistics/ - Jonathan C Brown, T. E. (2022). Risk Factors For Coronary Artery Disease. Florida: StatPearls Publishing.
