Blood moving through your arteries pushes against the arterial walls; this force is measured as blood pressure.

High blood pressure (hypertension) occurs when very small arteries (arterioles) tighten.  Your heart has to work harder to pump blood through the smaller space and the pressure inside the vessels grows.  The constant excess pressure on the artery walls weakens them making them more susceptible to atherosclerosis.

There are a number of ways to diagnose coronary heart disease. Your physician will probably use a number to make a definitive diagnosis.

A coronary angiogram uses a dye inserted into your arteries and an x-ray to see how the blood flows through your heart. The picture taken, the angiogram, will show any atherosclerosis.

Another test is an electrocardiogram.  This test records the electrical activity of your heart.  An electrocardiogram measures the rate and regularity of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart. It is a non-invasive procedure.

Smoking damages the lining of blood vessels, increases fatty deposits in the arteries, increases blood clotting, adversely affects blood lipid levels, and promotes coronary artery spasm. Nicotine accelerates the heart rate and raises blood pressure.

Diet plays a significant role in protecting or predisposing people to heart disease. Diets high in animal fat, low in fresh vegetables and fruit, and high in alcohol have been shown to increase the risk of heart disease.

Adopting a diet low in fat and salt has a protective effect over the long term. This means whole grains, fruits, and vegetables.

Estrogen does help raise good HDL cholesterol so protecting women, but once through the menopause as many women as men are affected by heart disease: but if a woman suffers from diabetes or has raised levels of triglycerides that cancels out the positive effect of estrogen.

Heart disease can run in some families. But even if you inherit the risks factors that predispose you to heart disease, such as high blood cholesterol, high blood pressure, diabetes, or being overweight, there are measures you can take that will help you avoid developing cardiovascular disease.

There are four valves which control the blood flow through the heart. They all consist of two or three flaps which swing open to allow blood through with each heart beat, and swing closed to prevent blood going back in the wrong direction.

Deoxygenated (blue) blood returning from the body collects in the right atrium. It flows to the right ventricle through the ‘tricuspid valve’. It is then pumped through the ‘pulmonary valve’ into the pulmonary artery on its way to the lungs. Oxygenated (red) blood returning from the lungs collects in the left atrium and flows through the ‘mitral valve’ into the left ventricle. It is then pumped through the ‘aortic valve’ into the aorta and to the body.

Estrogen does help raise good HDL cholesterol so protecting women, but once through the menopause as many women as men are affected by heart disease: but if a woman suffers from diabetes or has raised levels of triglycerides that cancels out the positive effect of estrogen

The phrase ‘congenital heart disease’ refers to the various abnormalities of the heart which are present at birth. Other words, such as disorder, defect, condition, or problem, may be used instead of disease.

There are three main types of abnormalities:

1. There may be a narrowing (called ‘stenosis’) in parts of the heart, in its valves, or in the blood vessels outside the heart. This narrowing obstructs the flow of blood and puts strain on the heart muscle. In severe cases, the flow of blood past the obstruction may be reduced.
2. There may be holes in the partitions (septums) between the chambers of the heart. These allow blood to flow from one side of the heart to the other (called ‘shunting’). As the blood pressure is higher in the left side, blood flows (shunts) from left to right and results in increased flow to the lungs. The normal communications present at birth may persist between the main blood vessels attached to the heart, e.g. Patent Ductus Arteriosus. This also results in increased blood flow to the lungs.
3. The main vessels may be attached to the heart at an abnormal location.

In this abnormality, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. Thus the dark blood returning from the veins is pumped back into the main circulation, resulting in ‘cyanosis’ (blueness of the skin). In the newborn period, the ductus arteriosus and the foramen ovale are still open and allow some bright blood to get into the circulation. The baby will then usually survive for a few days at least, until effective treatment and surgery can be arranged. Note: In some cases a combination of abnormalities may exist.

In this heart abnormality the way into the lungs from the right ventricle is narrowed (Pulmonary Stenosis). Some of the dark blood passes through the VSD into the aorta, resulting in cyanosis (blueness of the skin). Some affected babies may appear normal for several weeks or months before the blueness begins to develop as the narrowing becomes more severe

Abnormalities of the heart are present in nearly 10 in every 1,000 babies born. Some of these are mild and cause no significant disturbance to heart function. In many cases, such minor problems need no treatment and do not affect the life or the health of the child. More serious abnormalities are present in about five of these ten individuals with congenital heart problems.

The total frequency of all birth defects affecting different parts of the body is quite high. Some abnormality occurs in about 25 in every 1,000 babies born. This, however, includes many minor abnormalities.

In most cases the cause of the heart abnormality is unknown. By the end of the 7th week of pregnancy the heart is fully formed. It changes little in its basic structure until birth when the circulation of the blood alters as the lungs start to function. Major abnormalities in development of the heart must therefore occur early in pregnancy.

Parents will naturally worry about things which might have affected the formation of their child’s heart. In most cases the heart abnormality is only an unfortunate occurrence which has not resulted from any identifiable cause. However, in some cases there are genetic errors which are responsible for the problem. If this is at all likely you may be offered a consultation with a geneticist.

Some illnesses in a pregnant mother may result in abnormalities in her baby’s heart and vessels. One example is German measles (rubella), if contracted early in the pregnancy. Occasionally medications or alcohol taken during the pregnancy can cause problems – though small quantities of alcohol are not likely to cause harm. Many medications, which are needed during pregnancy for a wide variety of reasons and are prescribed by a doctor, do not lead to any damage to the baby. Smoking is certainly very undesirable during pregnancy, as it has adverse effects on growth of the baby and is associated with an increased rate of premature birth and stillbirth. However, there is no evidence linking smoking with heart problems in babies.

In most families, abnormalities of the heart do not occur in siblings. In a few families, however, subsequent children may be affected. While it is inevitable that parents will be anxious about the health of their next baby, the risks are usually low. When one child has a congenital heart problem, the risk for the next pregnancy is usually between 2% and 4% (i.e. 1 in 50 to 1 in 25). It is often possible to diagnose a major heart abnormality on an ultrasound scan carried out at around four months or later in the pregnancy. Mothers who have had a previous child with a heart problem will naturally hope that any new baby will be healthy. If they wish to have a scan in subsequent pregnancies, they will need to be referred to one of the experts in this specialised field. Such scans will usually be carried out at one of the major obstetric units in Melbourne or at the Royal Children’s Hospital.

About one third of affected babies develop symptoms in the early weeks of life. The abnormalities which are present in some babies lead to mixing of dark (blue) blood from the veins with the bright (red) blood from the lungs. The blood then flowing to the body and its organs is dark instead of being bright. This produces a bluish colour of the lips and skin (called cyanosis), hence the term ‘blue baby’.

In other children, even if blueness is not present, the heart may not be able to perform the extra work caused by the abnormality. Such children may develop symptoms, such as marked shortness of breath and difficulty with feeding. This is usually due to build up of fluid (congestion) in the lungs or other organs such as the liver. Doctors refer to this congestion as ‘heart failure’.

In at least half of the children with heart abnormalities, there are no symptoms and the disorder is recognised when the child has an illness, or during a routine examination. The condition is usually recognised by the presence of a heart murmur, heard with the doctor’s stethoscope while examining the heart. These murmurs result from turbulence in the flow of blood as the heart beats. Many heart abnormalities lead to greatly increased turbulence and hence produce quite loud murmurs. However, murmurs are not always due to heart defects and may have no significance. About 50% of children with normal hearts have faint heart murmurs. These ‘innocent murmurs’ tend to be more apparent during illnesses associated with fever, and this is when they are often detected.

If a heart defect is present, the nature of the problem and its severity must be assessed, and this will involve some tests. These are called non-invasive as nothing is introduced into the body during these tests. An X-ray and a recording of the electrical activity of the heart (ECG) are usually required. The most important test is an ultrasound scan of the heart (echocardiogram), which is similar to the scan which most mothers have during pregnancy. This test is not painful and involves no risk. Some children may need to be sedated with a mild medication so they can lie still to obtain the test results. With an echocardiogram, it is often possible to make a very precise diagnosis of the nature and severity of the heart problem. The test takes between 15 minutes and 1 hour to perform. Sometimes, especially with more complicated heart problems, the test may need to be repeated several times to obtain complete information.

If the baby has symptoms of heart failure in the early months of life, further investigations (e.g. cardiac catheterisation) may be required. The object of these investigations is to confirm the diagnosis and to obtain detailed information about the heart abnormality and its effects on the lung circulation. This information cannot be obtained by other means.

In many cases, especially where there is no evidence of strain on the heart, such tests may not be necessary or may be postponed until the child is older. They may often be carried out as part of the preparation for an operation.

The term ‘cardiac catheterisation’ refers to the passage of a fine tube (called a catheter) into the heart chambers through a vein, or an artery, usually from the top of the right leg just below the groin. By this means, blood samples and pressure measurements can be obtained from within the various chambers of the heart. This provides much information about the effects of the heart problem on the function of the heart and on the lung circulation. Usually, X-ray dye is injected to obtain pictures of the heart chambers and vessels (angiocardiography). These tests are only required when adequate information cannot be obtained by other methods (e.g. echocardiography), or when the cardiologist advises that the heart problem needs special treatment involving heart catheterisation (called an ‘interventional procedure’). Procedures of this latter type may be used to stretch open a narrow valve or blood vessel, using a catheter with an inflatable balloon. Alternatively, a tiny ‘spring coil’ may be inserted to block off an abnormal and unwanted blood vessel, or an expanding plug (usually referred to as a ‘device’) may be placed to close a hole such as an ASD or VSD.

A general anaesthetic will usually be given for these tests or procedures. The child will normally be admitted to hospital on the day of the test and discharged a few hours after it. Arrangements will be made to discuss the initial results of the test with the parents on the day of the procedure. The final results will often need to be discussed in conference (e.g. with the heart surgeons) before making decisions about further management, and so may not be available for several days.

The skin puncture, through which the catheter is inserted, does not usually need stitches, but there is often some bruising which will leave some soreness for a few days. Otherwise, there should be no ill effects after the procedure, though the anaesthetic may lead to nausea or vomiting for a few hours, and general tiredness for a day or two in some individuals.