However, there are other heart conditions that are more obscure, such as aortic dissection, aneurysm, and viral myocarditis. We will shed more light on these three critical and life-threatening conditions, which require immediate medical attention to prevent death.

What is it?

Aorta is the biggest artery in our body. It originates from the heart, makes a U-turn in the upper chest and ends around the umbilical area, with branches of artery supplying the whole body. Therefore, conditions that affect the aorta may affect the blood supply to certain organs, depending on which part of the aorta is involved.

Disease in the aorta can cause narrowing or, more commonly, abnormal dilatation of the artery. But the most dreaded disease that affects the aorta is aortic dissection, which is potentially life threatening. This is caused by disruption of the aorta wall, which allows blood to flow between the layers of the blood vessel wall. The origins of major branches from the aorta at the site of the dissection may be affected, thus compromising blood flow to respective major organs. Death, heart attack or stroke may ensue if arteries to the heart or brain are affected.

This condition is usually associated with high blood pressure or conditions that weaken the wall of the blood vessel (e.g. Marfan’s syndrome). Rarely, it can also happen during pregnancy in normal women.

What are the symptoms?

The symptoms of acute aortic dissection are usually dramatic with sudden, severe ripping chest or back pain. The pain may travel if there is extension of the dissection.

Other symptoms, depending on whether the origins of major arteries are involved, include heart attack, stroke, heart failure or shock.

How can it be diagnosed?

Patients with severe chest or back pain, especially those suffering from high blood pressure, are suspected of having aortic dissection. Chest X-ray showing widening of the tissue in the middle of the chest is suggestive of aortic dissection. However, CT (Computed Tomography) scan, MRI (Magnetic Resonance Imaging) or ultrasound is usually needed to confirm the diagnosis.

What is the treatment?

The most important treatment of aortic dissection is to reduce the blood pressure to prevent further extension of the dissection. This may be through oral medications, or intravenous medications if the initial blood pressure is high or not controlled with oral medications. Dissection affecting the initial part of the aorta will require surgery, sometimes urgently, as arteries to the heart and brain are usually involved. Dissection of other parts of the aorta is usually stabilised medically first. Surgery is required only if there is persistent pain or dissection.


Aneurysm

What is it?

Aneurysm is localised abnormal widening of the blood vessel due to weakening of the vessel wall. Although the widening of blood vessel can compress on important organs, the most dangerous complication of aneurysm is rupture of the aneurysm when it increases to a certain size. Aneurysms can occur in any artery, but rupture of aneurysms in the aorta or brain is usually fatal.

What are the symptoms?

Aneurysm is usually clinically silent and diagnosed incidentally or when it ruptures. But aortic aneurysm can cause deep, diffuse chest pain, or rarely, difficulty in swallowing (compression on gullet) or hoarseness (compression of nerve) when it grows bigger. Aneurysm in the brain may cause a headache.

Rupture of aneurysm of the aorta or brain is usually fatal due to severe shock caused by massive leakage of blood into the chest or abdomen and major stroke caused by haemorrhage in the brain, respectively.

How can it be diagnosed?

If large enough, aneurysm in the abdomen can be detected as a mass by examination. Otherwise, ultrasound, CT scan or MRI of the chest or abdomen is required to confirm the diagnosis. These investigations are also used to monitor the size of aneurysm over time to assess the risk of rupture and timing of surgery.

What is the treatment?

High blood pressure needs to be controlled to reduce the risk of expansion and rupture of aneurysm. Surgery is required when aneurysm reaches a certain size or is rapidly expanding, as the risk of rupture is high. Aneurysm of the brain is usually diagnosed when it ruptures causing a stroke. Immediate drainage of blood and surgical repair of the aneurysm are required to save lives and minimise brain damage.


Viral Myocarditis

What is it?

Myocarditis is the inflammation of the heart muscle due to infections, usually viral. This inflammation may eventually lead to global weakening and dilatation of the heart muscle causing severe heart failure (dilated cardiomyopathy). Certain viruses are known to cause myocarditis but the exact mechanism leading to the weakening of the heart muscle is unknown.

What are the symptoms?

Viral myocarditis is usually preceded by flu-like symptoms with fever, fatigue and palpitations. The diagnosis is difficult as the initial symptoms may be mistaken as a flu. It is usually when the patient presents with symptoms of heart failure (e.g. breathlessness) or abnormal ECG (Electrocardiogram) readings that lead to the diagnosis. Occasionally, it can also be mistaken as a heart attack.

How can it be diagnosed?

The diagnosis of myocarditis is usually based on diagnosis of exclusion because there are many causes of heart failure. Definite diagnosis of viral myocarditis can only be made with biopsy of the heart muscle, which is a high-risk test. However, there are usually some ECG and blood test abnormalities showing signs of heart muscle damage, while ultrasound of the heart (echocardiography) may show a dilated and weakened heart. Antibody to the virus may be high in patients with viral myocarditis and can be detected in the blood after a few weeks.

What is the treatment?

The treatment goal is to relieve symptoms of heart failure and there is no effective proven treatment for myocarditis. Usually medications for heart failure are recommended. Patients are usually advised to have bed rest during the period of infection. Occasionally, the heart function of patients with viral myocarditis may recover after a few months. Although the prognosis of patients who develop heart failure after viral myocarditis is poor, not all patients with viral myocarditis will develop a weakened heart.