What are the types of heart disease?

What are the types of heart disease?

There are many types of heart disease, which can be broadly classified as follows:

1. Coronary artery disease
2. Cardiomyopathy - weakened or inflamed heart muscle, or heart muscle damage from a virus
3. Rheumatic heart disease - heart valve damage from rheumatic fever
4. Infective endocarditis - heart valve infection from an infection elsewhere in the body
5. Congenital heart disease - heart defects present at birth
6. Other diseases or conditions related to the heart.

1. Disease of the coronary arteries

The cardiac muscles rely on nutrients and oxygen from the coronary arteries to function properly. If the coronary arteries become narrow or blocked, the cardiac muscles will not receive enough nutrients and oxygen, causing heart failure. The heart cannot pump blood to the body efficiently, resulting in symptoms of ischemia.

In cases of coronary artery spasm, symptoms of ischemia usually occur during physical exertion when the heart needs more nutrients and oxygen than normal. The symptoms may go away within a few minutes of rest. However, if the coronary arteries are severely constricted or blocked, the cardiac muscles may die, causing a heart attack. The heart cannot pump blood to the body efficiently, and the cardiac muscles work less effectively, resulting in more severe and longer-lasting symptoms, including heart failure.

Some patients seek medical attention for chest tightness or pressure that mimics indigestion or gastric ulcer. Some patients present with complications such as congestive heart failure, angina, or arrhythmia, and may even die before seeking medical help.

2. Cardiomyopathy or viral myocarditis

Cardiomyopathy can occur since birth or develop later in life. The most common type of cardiomyopathy that occurs later in life is cardiomyopathy of unknown cause. Cardiomyopathy of unknown cause can be divided into three types:

• Thickened heart muscle type
• Dilated heart muscle type resulting from certain diseases that infiltrate the heart muscle
• Non-thickened heart muscle type but with a heart that is enlarged and not able to contract normally

The most commonly encountered cardiomyopathy is dilated cardiomyopathy. This disease results from a decrease in the heart muscle's ability to contract, which leads to insufficient blood supply to various organs. The body compensates by enlarging the heart to increase the amount of blood pumped out of the heart. As a result, the patient's heart becomes significantly enlarged, and this condition is known as dilated cardiomyopathy. The main symptoms of this disease are easy fatigue and, in severe cases, swelling and shortness of breath due to heart failure. The cause of this type of cardiomyopathy is unknown, but it can sometimes occur after viral myocarditis or exposure to certain toxins, such as cobalt or cancer medications.

Several types of viruses can cause myocarditis. However, patients with this disease often have a history of fever and upper respiratory symptoms before developing easy fatigue from heart muscle inflammation, which impairs cardiac contraction. Most cases are mild and may not require medical attention, but in rare cases, severe myocarditis can lead to heart failure and even death, requiring immediate medical attention.

3. Rheumatic Heart Disease

There are two types of heart valve abnormalities: mitral valve prolapse and mitral valve regurgitation. Some individuals may have both conditions simultaneously. The main cause of these abnormalities in our country is rheumatic fever. Rheumatic fever usually starts in children aged between 5-12 years old after being infected with a bacteria called Streptococcus in the mouth. The body's immune system responds to the bacteria, but the reaction can be too strong, leading to resistance against normal tissues and resulting in rheumatic fever. Symptoms of rheumatic fever include fever, joint pain, joint swelling, skin rash, and the possibility of developing heart inflammation. Chronic heart inflammation can result in heart valve abnormalities (prolapse or regurgitation). Symptoms of heart valve abnormalities can occur from childhood to old age and depend on the severity of the valve's dysfunction. Valve abnormalities can occur in all heart valves, but the most common is mitral valve prolapse, followed by aortic valve prolapse. Mitral valve abnormalities are more common in women of reproductive age. Symptoms of mitral valve prolapse are often a sign of mitral valve regurgitation, which is a condition where blood flows back into the upper heart chamber because it does not flow through the valve properly. This can cause fluid to build up in the lungs, leading to fatigue, dizziness, swelling, and an increased risk of respiratory infections.

The general principle of treatment for mitral valve disease is to use medication to control the function of the heart. However, when the function of the heart deteriorates to the point where the patient begins to experience symptoms of heart failure, surgery must be performed to repair or replace the valve. If the condition is mitral stenosis and medication is not effective, surgery to enlarge or replace the valve must be performed once the valve reaches a point where symptoms appear.

Interestingly, we are currently seeing fewer cases of this disease, possibly due to the widespread use of antibiotics.

4. Infective endocarditis         

Most of the time, abnormalities of the heart valves occur first, such as heart valve dysfunction from rheumatic fever. These heart valve abnormalities are caused by inflammation that causes the shape of the heart valves to be distorted. When there is a bacterial infection in the bloodstream for any reason, such as a dental infection (filling, tooth extraction), the bacteria can easily adhere to the abnormal heart valves and spread, causing damage to the heart valves and leading to heart valve inflammation.

Patients usually come to see a doctor with symptoms of fever, chills, signs of infection in the bloodstream, or may present with symptoms of stroke, limb paralysis, from the fragments of disease-causing bacteria that have spread from the inflamed heart valves to various organs, or may present with symptoms of endocarditis, which is blood pooling in the heart muscle or heart valves that can cause damage to the heart muscle or heart valves.

Currently, there are more people who inject drugs into their bloodstream, leading to an increased incidence of right-sided infective endocarditis without preexisting abnormalities. This is due to the use of unsterilized injection equipment, which introduces infectious agents into the bloodstream. These infectious agents have a higher chance of attaching to the heart valve on the right side of the heart.

The treatment for infective endocarditis caused by infection involves hospitalization and high-dose antibiotic therapy administered through the intravenous route initially, followed by oral antibiotics for a period of 4-6 weeks. If symptoms persist or there are other complications, surgical intervention may be required.

5. Congenital heart disease

The cause of congenital heart disease is either genetic abnormalities or abnormal development of the heart tissue during fetal growth in the mother's womb. Abnormal growth of the tissue that develops into the heart can lead to incomplete heart structure, which can take on various forms. Some may have leaking heart walls (which can leak between the upper and lower chambers of the heart), while others may have no wall at all (with only one upper or lower chamber of the heart). In addition, some may have congenital heart murmurs or congenital heart valve leakage.

In some cases, the condition is more complex, such as in the case of Tetralogy of Fallot, which consists of several abnormalities, including leaking heart walls, heart murmurs, heart valve leakage, cyanosis, and a constricted pulmonary artery. This can make treatment more difficult.

Symptoms that patients present to physicians with vary depending on the type of congenital heart disease. They range from small size and failure to thrive, to easy respiratory infections or experiencing shortness of breath, to more complex types such as cyanosis and acyanotic types.

The most common congenital heart disease is Ventricular Septal Defect (VSD), where there is a hole in the wall that separates the two lower chambers of the heart. Generally, congenital heart diseases are treated through surgery, but currently, a closure device can be used in VSD cases. This device is inserted through a leg vein and guided to the heart, where it seals the hole by deploying the closure device, similar to heart catheterization. However, the effectiveness of this treatment depends on the size and location of the abnormality.

6. Other diseases or conditions related to the heart include:

• Rheumatic heart disease
• Arrhythmia
• High blood pressure
• Endocrine disorders such as toxic goiter, pituitary gland tumors, and adrenal gland tumors
• Malnutrition, such as vitamin B deficiency
• Diseases of the heart lining, such as pericardial effusion, chronic pericarditis, and constrictive pericarditis
• Vascular disorders, such as aortic aneurysm and aortic dissection

These diseases can cause abnormal heart conditions, which may be detected by an enlarged heart, rheumatic heart disease, and/or other specific symptoms.

Best regards,

Vibhavadi Heart Center Hospital