General Cardiology Problems

What is hypertension?

Blood pressure is, of course, the process by which our pumping hearts force blood around the body. We measure this force in millimetres of mercury (mm/Hg) and record it in two numbers separated by a dash:

Systolic pressure (the first number) – this is the pressure in your arteries when the heart pumps out blood

Diastolic pressure (the second number) – this is the pressure between beats of the heart as it relaxes

Blood pressure varies from person to person, but a normal reading is usually considered to be between 90/60mmHg and 120/80mmHg (and somewhat higher for people over the age of 80). So hypertension is a diagnosis and a label doctors use to describe blood pressure that is elevated beyond the normal range.

Why is hypertension a problem?

If your blood pressure is high, it means your heart is having to work harder to pump blood around the body. This puts strain on the heart, the blood vessels and other organs in your body. It can also cause the arteries to lose their normal elasticity so that they become stiffer or narrower. Left untreated, hypertension raises your risk of other serious heart and health problems, such as kidney failure, sight problems, heart attacks and heart failure (see below).

What does having high blood pressure feel like?

One of the problems with hypertension is that it rarely causes any noticeable symptoms. Research suggests almost a million people in Ireland have high blood pressure, but many won’t be of it. This is why it’s a good idea to have your blood pressure checked regularly, particularly as you get older. Where hypertension does cause symptoms, they can include shortness of breath, chest pain, dizziness and blurred vision.

What causes hypertension?

It’s often hard to pinpoint the exact cause of patients’ high blood pressure. But certain medical conditions and lifestyle factors certainly raise the risks of developing it. Lifestyle influences include:

• Smoking
• Drinking too much alcohol
• Gaining too much weight
• Not getting enough exercise

If a medical problem causes high blood pressure, this is known as “secondary hypertension”. Common examples include:

• A family history of hypertension
• Diabetes
• Kidney disease
• Sleep apnoea

Certain types of medicine, such as birth control pills and steroids, can also contribute to high blood pressure. The chances of developing hypertension increase with age too, particularly from 65 onwards.

How is it diagnosed?

High blood pressure is usually diagnosed with a simple blood pressure test. This might be a traditional arm cuff with a pump and dial. These days, however, it’s likely to be an automatic device with an inflatable cuff and a digital sensor that takes your pressure measurement. Since blood pressure can rise and fall during the day, you may be asked to take a monitor home with you to record several measurements. This type of device might be:

An ambulatory blood pressure monitor (ABPM) – to take readings over a longer period (eg 24 hours)

A home blood pressure monitor (HBPM) – to take additional readings as and when you choose.

How do we treat hypertension?

If you have consistently high blood pressure, there are several things we can do to help you reduce it. The first approach is to address any lifestyle issues that may be contributing to your hypertension. That could include things like stopping smoking, slimming down, building more exercise into your day and reducing the amount of salt you add to food and the amount of alcohol and caffeine you drink.

Depending on your blood pressure reading and your risk of further problems, you may also be offered medication too. Common types of hypertension medicine include:

Beta blockers – to help your heart beat less forcefully

Angiotensin-converting enzyme inhibitors (ACEs) – to relax the blood vessels

Angiotensin-2 receptor blockers (ARBs) – to relax the blood vessels

Diuretics – to help flush water and salt when you urinate

Calcium channel blockers – to widen the blood vessels

Bringing your blood pressure to a healthier level reduces your risk of developing a serious medical condition such as heart failure (see below), strokes and heart attacks. It can also help to prevent things from getting worse if you already suffer from one of these conditions. When you come into clinic, we will help you to develop a comprehensive plan for managing your hypertension over the weeks and months to come.

What is heart failure?

Heart failure is a condition where the heart muscles struggle to pump blood properly. This deterioration means your heart is unable to carry enough oxygen and nutrients around the body. It can also cause blood to back up in the heart and fluid to collect in the lungs, leading to breathlessness. Heart failure develops at different rates in different people; it can come on quite rapidly or it may set in over a much longer period of time.

What does heart failure feel like?

Heart failure can cause a number of unpleasant symptoms. Some common ones include:

• Dizziness
• Breathlessness
• A new and persistent cough
• Fatigue (either during activity or at rest)
• Light-headedness or fainting
• Nausea
• Swelling in the legs, ankles or feet
• Chest pain
• Rhythm problems, such as a fast heart rate

What causes it?

Heart failure usually happens as a result of the heart becoming weak or stiff through damage, which means it struggles to pump blood around the body in the normal way. There are a number of reasons why this might happen in the first place. Some common examples include:

Coronary heart disease – narrowed arteries reduce blood flow through the heart
Heart attack – an artery becomes completely blocked, damaging the heart muscle
Hypertension – high blood pressure (see above) means the heart has to work harder to pump blood
Heart valve damage – when the heart’s valves stop working in the normal way
Family history – if you have a congenital heart defect that reduces the efficiency of your heart
Lifestyle – certain lifestyle factors, such as obesity, smoking and excessive alcohol, can raise the risk of developing heart failure
Another condition – certain medical issues like diabetes, or an overactive or underactive thyroid, can damage the heart

Another potential cause of heart failure is an arrhythmia – a problem with the heart’s natural rhythm. When a heart is functioning normally, its two ventricles (lower chambers) work in tandem, regulating the amount of blood that’s being pumped within your body. If one of the ventricles falls out of sync with the other, the heart can no longer pump the right amount of blood. This can happen if the heart rate is disrupted by faulty electrical signals.

How is it diagnosed?

Diagnosing heart failure starts with a medical examination, where your consultant will ask you about your symptoms and your medical history. You may then be asked to do a test. Common tests for heart failure include:

A blood test – to look for markers of heart failure, such as a protein called B-type natriuretic peptide (BNP)
An X-ray – a scan of your chest to see if you have a lung condition or fluid on the lungs
An Echocardiogram – an ultrasound scan to examine the function of your heart, valves and blood flow
An ECG (electrocardiogram) – a simple way to check the rhythm and electrical activity in your heart

How do we treat heart failure?

Although there’s no cure for heart failure itself, there are a number of things we can do to help you protect your heart and manage your condition. Broadly speaking, the main focus of treatment is to control the symptoms you’re experiencing and prevent any damage to your heart from getting worse. The right course of treatment really depends on your own particular context and what’s causing your heart failure. These are things we will discuss with you in detail in clinic. Some of the broader approaches to heart failure, however, include:

Medication – medicines that seek to improve blood flow, lower blood pressure, control your heart rate, and so on
Lifestyle changes – actions and activities aimed at improving your health, such as reducing weight, stopping smoking or drinking less alcohol
Surgery – to improve blood flow in your heart, repair or replace a valve, or replace the heart itself (a heart transplant)

Another common way to treat certain types of heart failure is with a pacemaker. This is a tiny, battery-powered device that sits inside your chest and initiates heart activity to maintain a correct heart rate. A heart failure pacemaker is a specific type of pacemaker that can deliver a treatment called Cardiac Resynchronisation Therapy (CRT) to your heart. This device is designed to continuously monitor your heart rate; if it detects an irregularity, it can produce a series of electrical pulses that make the ventricles contract normally (in other words, to “resynchronise” them). You can find out more about these in our Heart Failure Pacemakers section. A CRT-ICD is a similar device, with an internal defibrillator to correct dangerous rhythm problems. You can read more about how it works in our CRT-ICD section.