Heart health

--Why is heart health important?

The heart is responsible for supplying oxygenated blood to every organ in the body, without this, the body cannot function. A healthy heart can respond to the demands of everyday life, physical activity and strenuous exercise, by changing the rate at which it beats and the volume of blood it pumps, or both.

--What is heart disease?

Heart disease refers to a range of acute and/or chronic health conditions affecting the ability of your heart to beat rhythmically and/or pump blood. Heart diseases can be related to lifestyle factors (smoking, poor diet, physical inactivity), related to infection (rheumatic heart disease), genetic or idiopathic (unknown cause). Unfortunately, heart and cardiovascular disease are a major global health issue. They are the single largest cause of death worldwide and one of the leading contributors to disability.

Common forms of heart disease include:

• Cardiac arrhythmias – where the heart beat is altered or irregular
• Coronary artery disease – where the blood supply to the heart itself is reduced (usually by fatty blockages or plaques in the arteries)
• Myocardial infarction (heart attack) – normally resulting from coronary artery disease, when a ruptured plaque leads to complete blockage of one or more coronary arteries
• Valvular disease – where the one-way valves inside the heart are narrowed or become floppy
• Heart failure – where the heart cannot adequately pump blood to the lungs and body

Heart diseases can occur in isolation or together – for example, when coronary artery disease or heart attack causes chronic heart failure.

--How do I know if I have heart problems?

Symptoms of heart disease are varied and do not always relate to the extent of disease. Symptoms may include chest, arm or jaw pain either at rest or with activity and exertion, palpitations (a slow, irregular or racing heart rhythm and/or pulse) and shortness of breath or dizziness. Some people with heart disease have no symptoms at all. For others the signs and symptoms may come on slowly. You may notice a steady deterioration in your fitness and ability to perform everyday activities.

In other cases, symptoms of heart disease may come on rapidly and may even cause death, such as a heart attack. Coronary heart disease, the most common form of heart disease, becomes more common as you age and is often associated with other health conditions, such as obesity and diabetes. Often people can blame symptoms such as pain and breathlessness on ’just getting older’ rather than have the symptoms investigated by their doctor. If you are in any way concerned that you may have heart disease, you should consult a medical practitioner – you may then be referred on to a cardiologist (heart specialist) for specialised tests or investigations.

If you are concerned that you may be having a heart attack, call for an ambulance on 000 immediately.

Common tests used by medical practitioners and cardiologists to assess heart health and diagnose heart disease include:

• Blood tests and chest x-rays
• Electrocardiogram (ECG) – electrodes are placed on the skin to measure the electrical activity across the heart
• Echocardiogram – an ultrasound examination of the heart
• Stress-test – a treadmill walking test combined with an ECG
• Coronary angiogram – a hospital procedure to examine blood flow to the heart

Heart disease may be treated by a combination of monitoring, medication, lifestyle modification, and medical and surgical procedures.

--How effective is physiotherapy for preventing heart conditions?

Physical inactivity and a sedentary lifestyle are known and preventable risk factors for coronary artery disease and heart attack. Physiotherapy therefore plays an important role in education, prevention programs and cardiac rehabilitation programs. Your physiotherapist can assess your exercise capacity and advise you on exercise training. Physiotherapists can also offer advice on other issues that people with cardiac disease may require such as airways clearance techniques in the post operative period and the management of pain and breathlessness.

Physiotherapists often work in secondary prevention programs (cardiac rehabilitation programs). These programs offer education, supervised exercise training and support for people with heart failure or following a heart attack, stent or heart surgery (cardiac events) and are strongly recommended. The programs can be delivered in a variety of ways – including hospital and community based programs or tele-health or health coaching. There is strong evidence that participation in cardiac rehabilitation programs help to reduce the risk of ongoing heart problems (heart attacks, hospitalisations) and improve people’s quality of life after having had a cardiac event.

--How effective is physiotherapy for recovery from a cardiac event or surgery?

Physiotherapists have an important role in the care of people who require (open) heart surgery such as coronary artery bypass graft surgery, heart valve repair or replacement. Your physiotherapist can provide you with respiratory (breathing and coughing) exercises to treat postoperative complications, such as chest infection and pneumonia. Respiratory exercises may be particularly important if you have respiratory conditions, such as chronic obstructive pulmonary disease (COPD).

Increasingly, postoperative physiotherapy focuses on helping you with early mobilisation and exercise. This restores you to a good level of physical activity and fitness and reduces postoperative musculoskeletal (bone and joint) problems. Early (in-hospital), supervised exercise after heart attack or heart surgery promotes recovery and provides a bridge to outpatient cardiac rehabilitation. On discharge from hospital, it is recommended that you attend a cardiac rehabilitation program close to home.

--What are some important lifestyle factors that help ensure a healthy heart?

There are a number of modifiable risk factors for coronary artery disease including smoking, high cholesterol, poor diet (high in saturated fats and salt), obesity, physical inactivity, high blood pressure and diabetes, and many of these risk factors are linked. Maintaining a healthy lifestyle is maintaining a healthy heart and includes stopping smoking, watching your diet, increasing your physical activity, taking your prescribed medication and having regular medical check-ups.

While it may not benefit you personally, undertaking a first aid course and learning CPR and how to use a defibrillator may help you to save someone’s life. St Johns and Australian Red Cross are just two Australian organisations that provide CPR and defibrillator training.

--What can I do at home?

Move more, and sit less. These simple recommendations from the Australian Department of Health are key to a healthy heart. Adults should aim to do 150 minutes of moderate intensity physical activity or 75 minutes of vigorous intensity physical activity each week.

Moderate intensity activities include fast walking, recreational swimming, golf and physical gardening. Vigorous intensity activities include circuit training, football, jogging and fast cycling. Your physiotherapist can recommend suitable activities for you.

If you are starting a new exercise program or joining a gym, it is important to have a general medical check-up (including your heart) before you start, especially if you have a family history of heart disease.

--Where can I get further information?

There are a number of websites, both Australian and international, that provide comprehensive and reputable information about heart health. These include:

• Heart Online 
• The Heart Foundation 
• The American Heart Association