Hesperian Health Guides

Other Heart Problems

Irregular heartbeat (arrhythmia)

Almost everyone has felt a very fast heartbeat, a “fluttering” or pounding in their chest, or was startled and thought their heart “skipped a beat.” These changes in heartbeat are called irregular heartbeat or arrhythmia. Changes in heartbeat are common, especially as people get older, and they are usually harmless. But some arrhythmias happen often, are dangerous, and require treatment.

If the changes in your heartbeat happen too often, they may affect your heart enough that you will have other signs. See a health worker if you often feel heart palpitations (a fluttering feeling in the chest or neck), skipped beats, or if they happen with any of these signs:

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  • rapid or pounding heartbeat
  • fatigue
  • dizziness, lightheadedness
  • fainting or near-fainting spells
  • shortness of breath
  • chest pain

Certain drinks, medicines, or drugs can cause or worsen an irregular heartbeat, including:

  • caffeine, found in coffee, some tea, and some bottled or canned drinks
  • nicotine, found in cigarettes and other tobacco products
  • alcohol
  • cold and cough medicines
  • anti-arrhythmics. Though unusual, the same medicines used to treat arrhythmia can sometimes cause arrhythmia! Health workers should carefully monitor a person taking antiarrhythmic medicine.
  • drugs such as cocaine, marijuana, and “speed” (amphetamines)

If you are being treated for irregular heartbeat and use any of these drinks, products, or substances, tell your health worker. They may be causing the problem, or they may make medicines to treat arrhythmia work differently.

Chest pain (angina)

Angina is the name for pain or discomfort in your chest. Angina may happen when you are more active or emotional than usual, and then go away when you relax. The pain is caused by narrowed or blocked blood vessels carrying blood to your heart.

Angina may feel like pressure or squeezing in your chest or shoulders, arms, neck, jaw, or back. Angina sometimes feels like indigestion. Your discomfort may be worse or you may also feel shortness of breath when walking, especially uphill.

Not all chest pain is a sign of heart disease. It could be something less serious, such as heartburn or indigestion. Take an antacid, and if that makes the pain go away, it is more likely the pain is from belly problems.

Pay attention to chest pain

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Chest pain can be a sign of a heart attack, although not all heart attacks cause chest pain. Chest pain can also be a sign of other serious conditions including lung infection, blockage of a blood vessel in the lung (pulmonary embolism), or the tearing of a major artery.

Because chest pain can be a sign of a heart problem, tests are usually needed to know if it is an emergency. Tests for heart problems given in a health clinic include blood tests, chest x-rays, or an EKG (electrocardiogram). In an EKG, wires taped to your chest measure how well your heart is working. None of these tests hurt. Treatment for chest pain might include changes in eating, medicines, or surgery.

If you sometimes feel pain in your chest and already know it is not an emergency, take notes about each time you feel the discomfort. Show these notes to your health worker. If you already take heart medicine, this information will help the health worker know how well it is working.

Include in your notes:

  • The date and number of times you felt the chest pain that day.
  • Anything that happened before the chest pain, such as exercising, feeling strong emotions, eating a large meal, going out in cold weather.
  • If the pain was mild, somewhat strong, or severe.
  • How long the pain lasted and if resting helped it go away.

The same changes in people’s food and lives that help with heart disease are helpful for angina: stop smoking, eat less oily and fried foods, drink less alcohol or none at all, and reduce stress. Exercise is helpful, but if you get chest pain during exercise, talk with your health worker about what kind of and how much exercise is safe. Medicines used for angina include calcium channel blockers, beta blockers, aspirin, and a type of medicine called nitrates.

Congestive heart failure

Congestive heart failure is a condition in which your heart is weak and beats with too little force to move your blood around well. This makes extra fluid collect in the lungs, legs, and other parts of the body. This makes you weak and, without treatment, eventually can cause death. But treatment can improve how well the heart works, make you feel better, and increase how long you live.

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Swollen legs, called edema, can be a sign of congestive heart failure.
  • Excessive tiredness and weakness. When your heart does not pump with enough force, your muscles do not get enough oxygen. You feel more tired.
  • Shortness of breath. Breathing is more difficult when there is fluid in your lungs. You may have difficulty breathing, especially when lying flat at night, and you may cough a lot. Your breathing may make a whistling sound.
  • Swelling (edema). Swelling from too much fluid can happen over a few days, or sometimes more gradually. You may have swelling in your feet and ankles and your clothes or shoes may feel tighter. This kind of swelling does not go away after lying down.
  • Swelling in the abdomen. Your liver may be swollen and feel bigger to a health worker doing an exam. Your belly may fill with liquid.
  • More frequent urination.
  • Eat less salt. Cook without much salt, add no salt to the food once it is prepared, and avoid canned foods, processed foods, or junk food like chips or crisps. Processed foods often have a lot of salt (sodium) even if they do not taste salty.
  • Medicines that help drain excess water from the body include “water pills” (called diuretics). Someone taking these medicines may need to eat plantains, bananas, oranges, lemon, or avocado daily to replace the potassium that some diuretics take out of the body.
  • Beta blockers, such as metoprolol, bisoprolol, and carvedilol, are also used to treat congestive heart failure. They need to be started at very low doses and increased slowly, especially if your blood pressure is already low. Work closely with your health worker.
  • ACE inhibitors, such as captopril, enalapril, or lisinopril, are also used to treat congestive heart failure. Some people get a cough from these medicines and should talk with their health worker to see if a different medicine would work better.

Rheumatic heart disease

Rheumatic heart disease affects mostly children and young adults. It is usually caused by untreated strep throat developing into rheumatic fever. Rheumatic fever often starts with pain in the joints, shortness of breath or chest pain, and uncontrolled or jerky movements. This needs immediate treatment with antibiotics. Without treatment, rheumatic fever causes infection and scarring in a heart valve. This blocks the valve and it no longer works well, like a little doorway that won’t open much. The heartbeat becomes weaker and the person does too. This permanent damage is called rheumatic heart disease. If the heart valve damage is not stopped or repaired, the person can die.

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Treat strep throat with antibiotics to prevent rheumatic fever. If a child does get rheumatic fever, he needs treatment every month to prevent heart damage.
  • A young person cannot walk 100 meters without getting out of breath.
  • A child needs to sleep propped up by pillows or she cannot breathe.
  • Using a stethoscope, a trained health promoter hears an abnormal heart murmur (the sound of blood moving through the damaged heart valve).
  • The health worker injects benzathine penicillin G once a month to prevent infections from returning and further damaging the heart. Do this at least until a child turns 18 years old.
  • If the heart is damaged, a valvuloplasty is a simple operation that opens a narrowed heart valve by inserting a thin tube (catheter) into an artery that leads to the heart valve. The blockage is opened by inflating a tiny balloon through it. If the rheumatic heart disease is more advanced, a more complicated operation can repair it.

Pregnancy and childbirth make the heart work hard. If a woman who had rheumatic fever or rheumatic heart disease gets pregnant, an experienced health worker should check her heart to see if the pregnancy might be dangerous for her. The health worker will also make sure any heart medicines the woman takes are not harmful in pregnancy. It will be safer to give birth in a hospital.

Rheumatic heart disease happens mostly to malnourished children in rural areas living in poverty and in overcrowded conditions, without access to safe water or sanitation, medicines, or health care. In countries that have addressed these conditions even partially, rheumatic heart disease has almost disappeared.

Babies born with heart defects

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Babies born with badly formed hearts sometimes die right after birth. Other problems, like a tiny hole between two sections of the heart, may sometimes go away without treatment. Many heart defects are serious but can be treated with operations or medicines. Some countries have special programs that offer heart operations for children at no cost.

Signs a baby may have a heart problem
  • Very fast breathing.
  • A baby that is not feeding.
  • A heartbeat that is too fast or too slow.

Using a stethoscope, a health worker listens to the baby’s heart for a heart murmur or too-fast heartbeat. An x-ray may be used to show the shape of the heart. An EKG, a test to measure the pattern of the baby’s heartbeat, may be needed.

Sometimes heart problems are found in older children or young adults. The cause is often a heart defect or rheumatic heart disease that was not treated.

This page was updated:02 Sep 2020