Heart disease

Heart disease has the potential to cause permanent disability and is a leading cause of death.

Introduction

Heart disease is a general term used to describe a number of acute (short-term) and chronic (long-term) medical conditions that affect the heart. Heart disease is common in the general population, including those of working age, and is the biggest cause of death in the UK. Although heart disease can have genetic causes, lifestyle choices have a large impact on its likelihood.

Medical emergencies such as a heart attack or cardiac arrest can be life-threatening, so it’s sensible to consider what you would do if one of your employees or visitors suffered one. The chances of surviving a heart arrest or heart attack are increased if emergency treatment is given as soon as possible. If the person becomes unconscious, use cardiopulmonary resuscitation (CPR) or a defibrillator.

Cardiac arrest, also known as cardiopulmonary arrest, happens when the heart stops pumping blood around the body. As a result, the person becomes unconscious and can’t breathe normally. Immediate CPR and/or defibrillation are needed for survival.

Heart attack, also known as myocardial infarction or acute coronary syndrome, happens when the blood supply to a part of the heart muscle is suddenly cut off due to a blood clot, causing severe injury or death of the heart muscle. A heart attack can cause chest pain, pain in the arms or other parts of the body, shortness of breath, nausea and anxiety. Immediate medical assistance should be sought (call 999 in the UK, or 112 from your mobile phone and throughout Europe).

Types of heart disease

There are many types of heart disease. The main conditions include the following (in alphabetical order).

  • Cardiac arrhythmia, such as atrial fibrillation, is an irregular heartbeat. The heart can beat too slowly, too fast or with an abnormal rhythm. There are various types of arrhythmia. Most are harmless but some can be life-threatening.
  • Cardiomyopathy is a disease of the heart muscle. It affects people of all ages and is usually inherited. The heart muscle becomes enlarged, thick or rigid, affecting its ability to pump blood.
  • Congenital heart disease is a problem with the heart’s structure and function that is present at birth. It affects about 1 in every 145 births.
  • Coronary heart disease (also known as ischaemic heart disease) is the most common type of heart disease and is the leading cause of death. Plaque builds up inside the blood vessels of the heart, obstructing the supply of oxygen-rich blood to the heart muscle. Coronary heart disease causes around 94,000 deaths in the UK each year. Angina is a symptom of coronary heart disease and affects about 2 million people in the UK.
  • Heart failure is a serious condition but is usually secondary to other heart conditions. It affects about 900,000 people in the UK. It is a condition in which the heart loses its ability to pump blood efficiently through the body. In other words, it can’t pump enough blood to meet the body’s needs.
  • Heart valve disease occurs if one or more of the valves in heart doesn’t work properly, resulting in extra strain on the heart, causing the heart to pump less efficiently.
  • Hypertensive heart disease is caused by high blood pressure. As the heart pumps against this pressure, it has to work harder, resulting in other heart abnormalities and dysfunctions.
  • Inflammatory heart disease is an inflammation of the heart muscles due to an infection that is usually caused by bacteria, a virus or from an internal abnormality, such as autoimmune disorder. There are three main types of inflammatory heart disease: pericarditis, endocarditis and myocarditis.
  • Marfan syndrome is a rare connective tissue disorder. Like other parts of the body, it affects blood vessels, causing damage to the heart.

Symptoms and signs

Symptoms vary widely depending on the severity and type of heart condition. The same heart condition may develop differently in different people. Typical symptoms include:

  • chest pain or chest discomfort
  • pressure or pain in the arms, neck, jaw or stomach
  • fatigue
  • breathlessness
  • irregular heartbeat
  • dizziness
  • numbness and tingling
  • nausea
  • pale, sweaty skin
  • loss of consciousness.

In the event of a heart attack or cardiac arrest, immediate medical attention (eg calling 999 or 112, CPR, defibrillation) is essential. Typical heart attack symptoms include:

  • pre-attack – pain in the chest, shoulder, neck and arms; anxiety; breathlessness; unusual fatigue; indigestion
  • during the attack – tightness and severe chest pains; severe pressure and pain in the arms, neck, jaw and stomach; shortness of breath; pale and/or sweaty skin; fast heartbeat; sudden fatigue; dizziness; nausea or vomiting; swelling or pain in the legs.

Risk factors

The best treatment for heart disease is prevention. A healthy diet and regular exercise in everyday life reduces the risk of heart disease. The main risk factors for heart disease include smoking, age, genetic history, ethnicity, high blood cholesterol, high blood pressure, obesity and diabetes. Other risk factors include poor diet, lack of exercise, excessive alcohol consumption, stress, extreme temperatures and possibly excessive noise.

The British Heart Foundation have more information on risk factors.

Statistics

Diseases of the heart and circulatory system (cardiovascular disease) account for almost 155,000 deaths in the UK and an estimated 17 million worldwide each year. Around 640,000 men and nearly 275,000 women currently living in the UK have had a heart attack and around one in seven men and one in ten women die from coronary heart disease.

Legal background

The law places duties on the employer to assess risks posed to their workers and, where necessary, to take action to safeguard health and safety, including health surveillance if appropriate.

The Health and Safety at Work etc Act 1974 requires employers to secure the health, safety and welfare of employees at work. This includes providing a safe place of work, safe systems of work, information and training.

The Management of Health and Safety at Work Regulations 1999 (as amended) require suitable and sufficient assessments of health and safety risks, especially for those with known health conditions, to be carried out.

The Workplace (Health, Safety and Welfare) Regulations 1992 require employers to provide adequate welfare for their employees.

The Health and Safety (First-Aid) Regulations 1981 require employers to provide adequate and appropriate first-aid equipment and facilities, making sure that employees receive immediate attention if they are taken ill or are injured at work.

The Equality Act 2010 imposes a duty on employers to make reasonable adjustments and provide legal defence against discrimination on the grounds of disability, including disability relating to a heart disease.

Rehabilitation

If an employee is suffering from an ongoing heart condition or has suffered a heart attack recently, it may be necessary to make some reasonable adjustments, such as changes to their working pattern, changes to a workstation or location, or time off to attend medical appointments. If the employee has been off sick for some time due to their heart condition, the employer might need to arrange a phased return to work once they’ve recovered. The employer should discuss any issues with the individual once they’re well enough and before they return to work, perhaps with the help of an occupational health adviser. Some of the leaflets and links in the following section provide more detailed information.

Developed in partnership with:

Dr Bob Jefferson FFOM CMIOSH, Newcastle University