diease

Cardiovascular Diseases


OVERVIEW OF Cardiovascular Diseases :

Cardiovascular disease occurs commonly in the heart and blood vessels. These diseases can affect one or many part of the heart and the blood vessels. A person might feel symptomatic or non symptomatic.


CAUSES :

High blood pressure: Increase in blood pressure increases the loss of blood supply to vital organs

High cholesterol: Intake of high amount of low density or very low density lipoprotein (VLDL and LDL)

results in blockages of vessels leading to loss of blood supply to vital organs.

Tobacco use

Diabetes

Familial history of heart disease

Obesity

Diet high in sodium, sugar and fat

Stress

Excessive alcohol use

Pre Eclampsia: Seizures occurring during the pregnancy which might me sometimes fatal to the pregnant women

Gestational diabetes: The diabetes occurring during pregnancy is termed as gestational diabetes.

Chronic Inflammatory or Autoimmune diseases:  Autoimmune diseases are the diseases which occurs when the individuals own immune system acts against oneself.

 


PATHOPHYSIOLOGY :

The following are the different types of the heart diseases:

Arrythmia: Problem with the electrical conduction system of the heart which can lead to abnormal heart rhythms or heart rates. The electrical conduction system of the heart monitores the transmission of impulses needed for the heart to function properly.

Atheroscelerosis: This refers to the blockage of the blood vessels by the fatty tissues. This leads to the reduced or lossed blood supply to the heart.

Valve diseases: problem with the heart valves either bicuspid or tricuspid valves the structure that mediates the to and fro movement of the blood in the heart. The valvular dysfunction includes valve tightening or leaking.

Coronary artery disease: This is the main complication of the heart attack. The main problem with the coronary artery diseases is the blockages is seen in the artery. These blockage can lead to the loss of blood supply to the heart.

Heart failure: Problem with heart pumping or relaxing functions which lead to fluid buildup and shortness of breath.

Peripheral artery disease: Problem with the blood vessels of the arms, legs or abdominal organs, such as narrowing  or blockages of the vessels.

Aortic disease: Aorta is an organ that mediates the flow of blood to the vital organs such as brain and heart. Such dilatation of the blood vessels is called Aneurysm.

Congenital heart disease:  Congenital disease refers to the disease that is present from the birth. It can affect different parts of the heart

Pericardial disease: It refers to the problem with the lining of the heart, including pericarditis and pericardial effusion. Pericarditis refers to the inflammation of the outer covering of the heart. And pericardial effusion refers to the collection of fluid in the outer surface of the heart.

Cerebrovascular disease: Problem with the blood vessels that deliver blood to the brain such as narrowing of blood vessels or blockages.

Deep vein thrombosis: Blockage in the veins, vessels that bring blood back from the brain or body to the heart.

 

Pathophysiology:

Increase in the level of the LDL , BP, Diabetes and smoking might leads to oxidative stress formation.

Oxidative stress formation results in endothelial dysfunction and smooth muscle activation.

OXIDATIVE STESS:

This term refers to the formation of the free radicals. This term refers to any molecule that contains an unpaired electron in the outer orbit. This unpaired electron makes the molecule highly reactive, leading the molecule to either donate an electron to another compound or take up protons from another compound to obtain a stable electron pair. This can attach to the cell organelles and other structures resulting in damage to the plasma membrane and other structures. The mitochondria are the major source for the ROS.  The mitochondria produces most of the body’s required adenosine triphosphate through the process of oxidative phosphorylation. Oxidative phosphorylation is the main source for ROS.

This results is decrease in Nitric oxide which might leads to increase in the tissue angiotensin converting enzyme, local mediators.

These might result in increase in the secreation of endothelin, platelet aggregation factor, cytokines, proteolysis and inflammation.

As a result vasoconstriction, thrombosis, inflammation and rupture of plaque occurs .

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • pain or discomfort in the centre of the chest,
  • pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.

 Difficulty in breathing

  • Shortness of breathe
  • Nausea or vomiting
  • Light-headedness or faintness
  • A cold sweat
  • Turning pale

The common symptom of stroke:

  • Numbness of the face, arm, or leg, especially on one side of the body
  • Confusion, difficulty speaking or understanding speech
  • Difficulty seeing with one or both eyes
  • Difficulty walking, dizziness and/or loss of balance
  • Coordination
  • Severe headache with no known cause
  • Fainting or unconsciousness.

 


DIAGNOSTIC :

Electrocardiogram:

Electrocardiogram:

The heart transmits electrical impulses and electrodes on the skin can capture these recorded impulses generated as the electricity travels throught the heart muscle. The heart which has  decreased blood supply has lower energy and conducts the electricity in a different way.

Stress tests:

During exercise the heart needs more amount of energy and it should work harder and if the heart could be monitored and evaluated during the execise a test might uncover abnormalities in heart function. The patient is asked to walk on a treadmill, to ride a bicycle while simultaneously electrocardiogram is performed. Medications such as persantine, dobutamine and adenosine can be used to stimulate the heart if the heart cannot carry out such difficult tasks.

Echocardiography:

Ultrasound examination of the heart to evaluate the anatomy of the heart valves, muscles and its function are observed. This test might carried solely or it might be combined with other test such as the stress test.

Nuclear Imaging:

A radioactive tracer is injected into the vein and that can be used to indirectly assess blood flow to the heart. Technetium or thallium can be injected while a radioactive counter is used to map out how heart muscle cells absorbs the radioactive chemical and how it is distributed in heart muscle cells may help to determine indirectly whether the blockage exists or not. An area with no uptake of radioactive element suggest that the area is not getting the proper blood supply.

Cardiac Computerized Tomography and Magnetic Resonance Imaging:

Using these test the coronary arteries can be evaluated including hoe much calcium is present in the artery walls and whether blockage or narrowing of artery are present.

Cardiac Catheterization:

A thin tube is inserted through an artery in the groin, elbow, wrist into the coronary arteries. Dye is injected to assess the anatomy and whether blockages are present. This is called as Coronary Angiogram.

If the blockage exist it is called as angioplasty and the treatment to dilate the constricted vessel is known as Angiogram, a balloon is positioned at the site of obstructing the plaque.

A stent can be place din the blood vessels to dilate the narrowed blood vessels.

Holter and Event monitors:

These are portabale monitors and records the electrical activity during normal daily activity. A Holter monitor records the heart’s electrical activity for 24 -48 hours. An event monitor record the electrical activity of the heart only at certain times.

Myocardial Biopsy:

During this procedure your doctor might place a piece of heart in the microscope and he might look for the oppurtunities.

Genetic testing:

The genetic testing might reveals that the cardiomyopathy runs in the family or not.


TREATMENT AND PROGNOSIS :

Medical procedures to treat heart disease can include:

  • Angioplasty:
    • It is a procedure that involves special tubing with an attached deflated balloon that is threaded up to the coronary artery. The balloon is inflated to widen the areas that are blocked where blood flow to the heart has been slowed or cut off.
    • Stent placement involves a wire mesh tube, called a stent, that is used to prop open an artery during an angioplasty and stays in the artery permanently.
  • Bypass surgery:
    • It  treats blocked arteries by removing arteries or veins from other parts of the body and using them to reroute blood around arteries that are clogged in order to improve blood flow to the heart.
  • Radiofrequency ablation :
    • It involves a catheter with an electrode at its tip being guided through the veins to the heart muscle. The catheter is placed at the exact site in the heart where electrical signals stimulate the abnormal heart rhythm.
  • Heart transplant:
    • It  is a procedure that’s performed in the most serious of circumstances, when a heart is irreversibly damaged. The procedure involves removing a diseased heart and replacing it with a healthy one from an organ donor. 


PROGNOSIS :

When followed with regular checkup and medications, lifestyle are maintained properly it might give good prognosis. The 15 year survival rate who is diagnosed with heart attack is 45%.

 


PREVENTION :

Avoid alcohol consumption

Avoid smoking

Reduce the fat foods

Be physically active

Reduces the stress

Reduce the intake of salt

Maintain good sleep


Medicines used in the Treatment :

Anticoagulants:

  • Dabigatran
  • Edoxaban
  • Heparin 
  • Warfarin

Antiplatelet agent:

 Aspirin

Dipyramidole

Clopidogrel

Angiotensin converting enzyme:

Enalapril

Lisinopril

Captopril

Fosinopril

Angiotensin 2 receptor blocker:

Telmisartan

Losartan

Valsartan

Olmesartan

Beta blockets:

Atenolol

Metaprolol

Satalol

Propranolol

Calcium channel blocker:

Verapamil

Diltiazem

Nifedipine

Amlodipine

Felodipine

Statins:

Atorvastatin

Lovastartin

Diuretics:

Acetazolamide

Furosemide

Spironolactone

Metalozone

Vasodilators:

Isosorbide dinitrate

Isosorbide mononitrate

Nitriglycerine

Hydralazine

 


REFERENCE :

https://www.webmd.com/heart-disease/guide/diseases-cardiovascular

https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

https://www.medicalnewstoday.com/articles/257484

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.114.008729

https://my.clevelandclinic.org/health/diseases/21493-cardiovascular-disease