A
aldosterone
a mineralocorticoid produced in the renin-angiotensin-aldosterone system (RAAS) that acts at the distal tubule, retaining sodium and therefore water, thus keeping up the fluid level
aldosterone blocker/antagonist
blocks the renin-angiotensin-aldosterone system (RAAS), releasing sodium and water, which then passes from the body as urine; most used drugs are spironolactone and eplerenone
angiogram
contrast (dye) injected into a patient that outlines the coronary arteries in exquisite detail, giving information about the location, the quality and nature of the plaque, the degree of stenosis and the size of the vessel affected  There are two types of coronary angiogram:
CT coronary angiogram or a CCTA, a coronary computed tomography angiogram, which is non-invasive, and
‘invasive’ angiogram as it requires a small tube to be passed from an artery in the arm or leg to the heart to inject dye directly into the arteries
angiotensin II (AT2)
works on the angiotensin II receptor and causes vasoconstriction – keeps up the blood pressure; dilates the kidney’s efferent arteriole and so reduces filtration  The resultant fluid overload places a strain on the heart that could be detrimental to a heart in cardiac failure
angiotensin II (AT2) receptor
drives much of the action within the renin-angiotensin-aldosterone system (RAAS), including the production of aldosterone
angiotensin II (AT2) receptor blocker (ARB)
acts directly on the AT2 receptor in the renin-angiotensin-aldosterone system (RAAS), releasing sodium and water, which then passes from the body as urine; lowers blood pressure, constricts efferent arteriole, lessens aldosterone production  Commonly used drugs are candesartan, telmisartan and valsartan  Should not be given with ACE inhibitors, although they are interchangeable
angiotensin-converting enzyme (ACE)
the enzyme that converts angiotensin I (AT1) to angiotensin II (AT2)
angiotensin-converting enzyme (ACE) inhibitor
blocks the renin-angiotensin-aldosterone system (RAAS) – prevents the conversion of AT1 to AT2 – releasing sodium and water, which then passes from the body as urine  Used for patients whose hearts are not pumping well – hearts with reduced ejection fraction (HFrEF)  Current commonly used drugs include enalapril, perindopril and ramipril  Should not be given with ARBs, although they are interchangeable
anticoagulant
a blood thinner that slows down the formation of a clot and so helps reduce the risk of a clot forming; common agents are warfarin, heparin and non-vitamin K oral anticoagulants
 
antiplatelet
blood thinner that prevents blood components – platelets – from clumping together; helps reduce the risk of a clot forming; common agents are aspirin and clopidogrel
atrial fibrillation (AF)
an ‘irregularly irregular’ heartbeat, characterised by the loss of the coordinated contraction of the top part of the heart, the atrial chambers, or atria  It affects the pumping capacity of the heart  The condition can be managed but not cured  AF distinctions:
overt or symptomatic AF
the type the patient can feel
silent or asymptomatic AF
the type the patient cannot feel and is discovered as an incidental finding
paroxysmal AF
lasts between 24 and 48 hours but no longer than a week
persistent AF
lasts longer than seven days
permanent AF
is present for longer than a year
valvular AF
if the patient has a narrow mitral valve or artificial heart valve; is associated with a greater risk of a clot forming in the left atrial appendage
arteries
the vessels of the body’s circulation system that carry the blood away from the heart
aorta
the biggest artery of the body, takes the blood from the left ventricle as the blood begins its journey around the body  Coming from the aorta as it leaves the heart are
the right coronary artery (RCA) which provides blood to the surface of the heart, the area nearest the diaphragm, and
the left main coronary artery (LM) which divides into
the left anterior descending artery (LAD) and provides blood to the anterior surface of the heart, the area nearest the chest wall, and
the circumflex artery which provides blood to the back of the heart, the area
nearest the spine
coronary arteries
are the first branches in the body’s circulation system and supply oxygenated blood to the heart muscle
carotid arteries
a pair of major blood vessels in the neck that deliver blood to the brain and head
left internal mammary artery (LIMA)
an artery behind the sternum that supplies blood to the chest wall; considered a conduit of choice in coronary artery bypass graft (CABG) surgery  Also known as the internal thoracic artery (ITA)
 
radial artery
supplies blood to the forearm and the hand; can be used as the conduit in coronary artery bypass graft (CABG) surgery
associations
connected, joined or related to
asymptomatic
producing or showing no symptoms
atrium
a pre-pumping chamber of the heart  There is an atrium on each side of the heart
the right atrium moves blood from the body through the right ventricle to the lungs,
the left atrium moves blood from the lungs through the left ventricle into the body
automaticity
an automatic depolarisation system of the cells of the heart

B
beta-blockers
drugs frequently used to control the heart rate  They
dampen the over-drive effect of the sympathetic nervous system which has nerve endings supplying the AV node, reducing the speed of electrical conduction from the atria to the ventricles and thus slowing the heart rate, and
target the high density of beta receptors (specifically beta2 receptors) in the heart;
improve mortality, morbidity and quality of life for people with reduced cardiac function
commonly used drugs are metoprolol, carvedilol, bisoprolol, extended-release metoprolol and nebivolol
bisoprolol
a commonly-use beta-blocker; others include carvedilol, extended-release metoprolol and nebivolol
blood
the bodily fluid that transports oxygen and nutrients to the body and removes carbon dioxide and other waste  Among its components are platelets (which help in clot formation)
blood clot (thrombus)
a soft, thick lump comprising platelets and fibrin to prevent blood loss if a blood vessel is damaged  A clot can also form inside an artery or vein and stop or block the normal flow of blood  This situation can be very dangerous  If it dislodges and travels though the circulatory system, this is called embolization and can cause a major disaster within the body, such
as stroke, pulmonary embolism, deep vein thrombosis (DVT), kidney failure or pregnancy complications
blood flow restoration
procedures to restore blood flow to blocked arteries that include the implantation of a stent/s or bypass grafting
 
C
calcium channel blocker
stops calcium from entering the cells of the heart and the arteries; used for high blood pressure, chest pain and irregular heartbeat; common agents include nifedipine and amlodipine (peripherally-active) and diltiazem and verapamil (centrally-active); agents best avoided in the presence of cardiac failure
candesartan
a commonly used AT2 receptor blocker (ARB); can be used for high blood pressure  Valsartan and telmisartan are other commonly used ARBs
captopril
the first of the angiotensin-converting enzyme (ACE-I) inhibitors, a powerful agent developed in the 1990s for the treatment and management of congestive heart failure in people with decreased LV function, or reduced contraction of the heart  Its use provides improved quality of life, morbidity and mortality  Later, similar drugs include enalapril, perindopril and ramipril
cardiac arrest
occurs when the electrical impulses of the heart malfunction, leaving the heart unable to pump blood to the body  The symptoms are immediate, with the person non-responsive and not breathing  It can happen to anyone at any time  The causes vary  Without immediate action (CPR and defibrillation), only a small percentage of sufferers survive
cardiac failure (CF)
the heart does not pump as well as it should, leading to a complex mix of a sick heart, maladapted responses to impaired circulation and fluid retention that further strains the heart into a downward spiral of deterioration
cardiac failure, acute
when the heart fails, suddenly; a medical emergency
cardiac imaging
any method used to image the muscle, valves and arteries of the heart
echocardiography – assesses dynamic function of muscle and valves
CT imaging – assesses the health and structure of the arteries in a non-invasive way
invasive angiography – provides the clearest picture of the narrowing of the arteries
magnetic resonance imaging (MRI)/ cardiac magnetic resonance (CMR) – shows scarring within the heart and inflammation, in exquisite detail
nuclear medicine – assesses aspects of cellular function, blood flow and heart function
cardio-pulmonary resuscitation (CPR)
is an emergency lifesaving technique, of hard and fast chest compressions in association with mouth-to-mouth resuscitation, used when someone’s breathing or heartbeat has stopped  Even if untrained and uncertain about what to do, it is always better to try something than to do nothing  The difference between doing something and doing nothing could be someone’s life
cardiovascular disease (CVD)
general term for conditions affecting the heart or blood vessels; includes coronary heart disease, angina, heart attack, congenital heart disease, stroke and vascular dementia
 
coronary artery bypass graft (CABG)
a major surgical procedure used to treat coronary artery disease (CAD), in which part of a healthy vein or artery is used to divert blood around narrowed or clogged arteries to improve blood flow to the heart muscle
coronary artery disease (CAD) or coronary heart disease (CHD)
the process of atherosclerosis, or plaque build-up, in the artery that leads to a narrowing of the artery and reduced blood flow  If left undetected, this can produce symptoms including angina, shortness of breath, and lead to a heart attack
carvedilol
a commonly-used beta-blocker; others include bisoprolol, extended-release metoprolol and nebivolol
causations
factors/actions that cause the problem
CHADS / CHA2DS2-VA score
indicates the risk of stroke; used in atrial fibrillation management decisions
co-morbidities
other serious conditions suffered concurrently with the primary health problem

D
dapagliflozin
sodium-glucose transport inhibitor (SGLT2 inhibitor); see gliflozin
depression
a common illness worldwide that is characterised by severe and prolonged low mood; is different to usual mood fluctuations and short-lived emotional responses to challenges in everyday life  The affected person can suffer greatly and function poorly  At worst, it can lead to suicide
diltiazem
a calcium channel blocker that should be avoided in the presence of cardiac failure; also verapamil
disease
a symptom or loss of normal function
distal
situated away from the centre
diuretic
medication to make a patient pass fluid – relieves congestion and reduces strain on the heart
diuretic, loop
medication that works by blocking the concentrating mechanisms within the loop of the renal tubule, the Loop of Henle; the most used drug is furosemide (frusemide)
dual antiplatelet therapy (DAPT)
two drugs, such as aspirin and clopidogrel, which block platelet function, used together as a blood-thinning therapy after stent implantation
 
E
echocardiogram (echo)
echo, sound, cardio, heart, gram, picture
a scan of the heart using ultrasound waves to acquire a picture  It gives information about the valves, the chambers of the heart and pressures within the heart
electrocardiogram (ECG)
a trace of the electrical activity through the heart acquired by electrodes  It shows the rhythm of the heart  Features of an ECG can be used to determine the status of the heart muscle
P wave
electrical activity in the atria, reflecting actual depolarization or the electrical flow  No P wave with chaotic electrical activity is the diagnostic thumbprint of atrial fibrillation
QRS complex
created by the electrical impulses reflecting the depolarisation of the major muscle of the heart
T wave
the return of normal repolarization to the heart muscle ready for the next beat
empagliflozin
a gliflozin or sodium-glucose transport inhibitor (SGLT2 inhibitor)
enalapril
one of the ACE inhibitor drugs currently used in the treatment and management of congestive heart failure in people with decreased left ventricle function, or reduced contraction of the heart; providing improved quality of life, morbidity and mortality; other similar drugs include perindopril, ramipril and captopril
eplerenone
a common aldosterone antagonist that works on the distal tubule
extracorporeal membrane oxygenation (ECMO)
a machine, very similar to a bypass machine, that takes blood from the patient to transfer oxygen through a membrane outside the body to maintain oxygenation to the person; used for critically unwell patients with a good chance of recovery

F
furosemide (frusemide)
one of the most used loop diuretic drugs

G
gliflozin
the sodium-glucose transport inhibitor (SGLT2 inhibitor) that
works at the proximal tubule of the kidney, allowing salt and water to be lost through the urine; developed initially to aid diabetics
reduces hospitalizations
improves quality of life especially for diabetic patients with CF, and improves mortality;
 
the first drug identified to provide benefit in cardiac failure was empagliflozin, while a 2019 report to the European Society of Cardiology showed that the drug, dapagliflozin, was a beneficial add-on therapy for cardiac failure patients already appropriately treated regardless of whether or not they had diabetes  The SGLTs-1 drugs are now included as routine therapy for patients with reduced ejection fraction cardiac failure
glucagon-like peptide-1 receptor antagonist (GLP-1 RA)
a drug for diabetes that appears to reduce cardiac events; agents include semaglutide,
dulaglutide and exenatide

H
HAS-BLED score
indicates risk of bleeding; used in atrial fibrillation management decisions
heart
a large muscle that pumps blood through the body
heart attack
a non-medical expression  It is a layman’s term referring to a myocardial infarction
myo, muscle, cardio, heart, infarction, death by lack of blood flow
most commonly, but not always, it is caused by the narrowing of the coronary arteries that can kill or requires some form of medical intervention – medication, time in hospital, balloons or stents, or coronary artery bypass grafting  There are two types of heart attack:
NSTEMI – non -ST-Elevation Myocardial Infarction, in which the coronary artery is partially and temporarily blocked
STEMI – ST-Elevation Myocardial Infarction, in which the coronary artery is completely and permanently blocked
The type of heart attack is determined by the results of the ECG  While the NSTEMI is the less serious of the two because less damage is done to the heart, it is still a serious condition that requires immediate diagnosis and treatment

L
Loop of Henle
a region between the proximal and distal tubules of the kidney where concentration of urine may occur; a region where certain diuretic drugs (loop diuretics) work

M
metoprolol
a commonly-used beta-blocker, for heart rate control; others include bisoprolol, carvedilol and nebivolol; available in an extended-release preparation for CF
mineralocorticoid
mineralo, mineral balance; corticoids, steroid-based hormones
hormone messengers that influence electrolyte and water balance in the body; the primary mineralocorticoid is aldosterone
 
mineralocorticoid blocker
can be used as a diuretic  If used in conjunction with a loop diuretic, particular care needs to be exercised around fluid balance and fluid loss, with regular blood testing and clinical assessment essential
myocardium
myo, muscle, cardium, being of the heart the muscle of the heart
N
nebivolol
a commonly-used beta-blocker; others include bisoprolol, carvedilol and extended-release metoprolol
neprilysin inhibitor
helps stop the breakdown of the natriuretic peptides (good guys); cannot be used in conjunction with ACE inhibitors; most commonly used drug, sacubitril
nitrates
relax the blood vessels and reduce the load on the heart; cannot be used with Viagra-type preparations; commonly used agents are based on isosorbide mononitrate
nodes
sinoatrial (SA) node
a cluster of specialised heart cells located in the top of the right atrium and it is where the electrical activity of the heart originates and drives the rhythm of the heart
atrioventricular (AV) node
a cluster of cells in the centre of the heart between the atria and ventricles that allows electrical communication; also acts as a gatekeeper, regulating the electrical impulses as they come from the atria and enter the ventricles
non-vitamin K anticoagulants (NOAC)
relatively new, fast-acting anticoagulants; commonly used agents are apixaban, dabigatran and rivaroxaban

P
palpitations
arrhythmic, or irregular, heartbeats
rapid and irregular
atrial (top of the heart) ectopic (out of place) beats (heartbeat) extra beats arising from the top part of the heart
ventricular ectopic beats
extra beats arising from the ventricle
rapid and regular
atrial flutter
similar to atrial fibrillation except that the heart beat is regular and there is a re-entrant circuit occurring in the right atrium
 
supraventricular tachycardia
supra, above the ventricle, tachy, fast, cardia, pertaining to the heart an electrical short circuit in the atria that keeps firing on itself
ventricular tachycardia
a high-risk rhythm in the main pumping chamber of the heart
ventricular fibrillation
a cause of sudden cardiac death
perindopril
one of the ACE inhibitor drugs currently used in the treatment and management of congestive heart failure in people with decreased left ventricle function, or reduced contraction of the heart; providing improved quality of life, morbidity and mortality; other similar drugs include, enalapril, ramipril and captopril
prognostic (prognosis)
improving the long-term outcome for the patient
proximal
situated near the centre

R
ramipril
one of the ACE inhibitor drugs currently used in the treatment and management of congestive heart failure in people with decreased LV function, or reduced contraction of the heart; providing improved quality of life, morbidity and mortality; other similar drugs include enalapril, perindopril and captopril
renin-angiotensin-aldosterone system (RAAS)
the chemical messenger system that regulates blood pressure through the kidneys; produces aldosterone (keeps sodium in the kidneys – increases fluid volume in the body)
renin-angiotensin-aldosterone system (RAAS) blocker
releases sodium and water, which pass out of the body as urine  Therapies include angiotensin- converting enzyme (ACE) inhibitors, angiotensin II (AT2) receptor blockers, aldosterone blockers
rhythm
sinus (normal)
the healthy heart rhythm, which is controlled by the sinoatrial, or sinus, node, beating in asynchronistic and smooth manner
arrhythmia
when the synchronicity of the heartbeat breaks down

S
sodium-glucose transport inhibitor (SGLT2)
see gliflozin
spironolactone
a common aldosterone antagonist that works on the distal tubule in the kidney
 
stenosis
narrowing
stenting
a mechanical intervention for coronary artery disease in which an intravascular device (balloon) within a wire scaffold is inserted percutaneously (through the skin) and guided to the site of the narrowing  When the balloon is inflated, the artery is opened  When the balloon is removed, the wire scaffold remains to keep it open  The scaffold is called a stent
stress test
a test of heart function  It involves exercising the patient or giving the patient medication to replicate exercise, to try to reproduce the symptom under investigation or unmask areas where there is a lack of blood flow to the heart
stroke
a disruption of the blood supply to the brain leading to permanent loss of function
haemorrhagic
when a blood vessel ruptures and bleeds into the brain
ischemic
when a clot (also called thrombus) blocks an artery, leading to a lack of blood flow  Such clots often form in the large blood vessels in the neck, the carotid arteries, or in the heart because of atrial fibrillation
sublingual glyceryl trinitrate (GTN)
a spray under the tongue, to be used when a person experiences chest pain (angina); it is given with some caution; not to be used with Viagra
symptomatic improvement
improving how the patient feels

T
telmisartan
a commonly used AT2 receptor blocker (ARB); can be used for blood pressure  Candesartan and valsartan are other commonly used ARBs
troponin
a protein found in the heart that is leaked into the blood when the heart is damaged or stressed  A blood test to measure troponin is used as a predictor when a person presents with chest pain to assess the likelihood of the heart being involved
thiazides
a mainstay of blood pressure therapy, they
block the sodium (salt) retaining function of the distal convoluted tubule in the kidney (the resulting salt and water loss reduces blood volume and so lowers blood pressure) and

lower blood pressure by dilating (relaxing or widening) the blood vessels
 
V
valsartan
a commonly used AT2 receptor blocker (ARB); can be used for high blood pressure  Candesartan and telmisartan are other commonly used ARBs
valves
keep blood flowing through the heart in the right direction (in order of blood flow)
tricuspid
a one-way valve between the right atrium and the right ventricle
pulmonary
a one-way valve between the right ventricle and the pulmonary circulation, which takes the blood to the lungs
mitral
a one-way valve between the left atrium and the left ventricle
aortic
a one-way valve between the left ventricle and the aorta, which is the main artery leading from the heart into the body
valve repair/replacement
the mitral valve and the aortic valve, both on the left side of the heart, can become too tight (stenosis) or leak (regurgitation or incompetence)
mitral valve
can be repaired (preferred) or replaced using metallic or biological tissue
aortic valve
can be replaced either by open-heart surgery or for a tight aortic valve, by minimally invasive technology called transcutaneous aortic valve implantation (TAVI)
veins
low pressure blood vessels that mostly carry deoxygenated blood towards the heart  The ones that most concern us are:
IVC, inferior vena cava
is one of two major veins that drains into the right atrium; it collects blood flowing below the
heart
jugular vein
carries blood from the brain, face and neck, and connects with the SVC to take the blood to the right atrium; a ‘dipstick’ for fluid pressure in the right atrium (the waveform of the jugular pulse is often visible in patients with a sick heart when sitting upright)
pulmonary veins
are the exception, and the four pulmonary veins transfer oxygenated blood from the lungs to the left atrium of the heart
saphenous vein (the great saphenous vein, GSV)
is the longest vein in the body; part of the vein, taken from the calf or thigh, is a commonly used medium in coronary artery bypass graft (CABG) surgery, with a 40-50 per cent failure rate after 10 years
 
SVC, superior vena cava
is one of two major veins that drains into the right atrium; it collects blood flowing above the
heart
ventricle
the main compression (pumping) chamber of the heart that pushes the blood through the body  There is a right and the left ventricle
right ventricle
pumps the oxygen-poor blood into the lungs
left ventricle (the main pumping chamber of the heart) pumps oxygen-rich blood into the body
verapamil
a calcium channel blocker that should be avoided in the presence of cardiac failure; also diltiazem
viable heart muscle
heart muscle that is not receiving enough blood but is still alive; also known as hibernating myocardium