Table of content

• What does the heart do?

• What are the different types of cardiovascular diseases?

• What are the effects of cardiovascular diseases (CVD)?

• What is heart failure?

• What are the cardiovascular disease symptoms?

• What tests and investigations are needed?

• How are cardiovascular diseases treated?

• Can I prevent cardiovascular diseases?

• FAQ ON Cardiovascular disease, Symptoms, Risk Factors and Treatment

Introduction

• Cardiovascular diseases (abbreviated as CVD) are a group of disorders affecting the heart and the blood vessels. They are the world’s leading cause of death, claiming millions of lives every year. A majority of these deaths due to cardiovascular diseases are seen in the developing nations due to lack of access to early diagnosis and treatment. But, the developed nations are at no loss of deaths due to CVDs because of high rates of obesity, diabetes and hypertension that can serve as serious risk factors for cardiovascular diseases. 

• India, one of the largest developing nations, has a high prevalence of cardiovascular diseases. Here, the onset of CVD is at an early age and if left untreated, could progress rapidly ending in fatalities.

• The incidence of cardiovascular diseases is 47% in developing countries and 27% in developed countries amongst people below seventy years of age. 

What does the heart do?

The heart is a vital, pump-like organ whose functioning is tightly regulated. The right side of the heart receives deoxygenated (oxygen-poor) blood from the rest of the body via veins and sends this deoxygenated blood to the lungs. In the lungs, oxygen that is taken inside by breathing is mixed to this blood, now making it oxygenated (oxygen-rich). This oxygenated blood is now received by the left side of the heart. The left heart now sends this fresh blood to all parts of the body via arteries. The different organs use this oxygenated blood for their nutrition and functioning.

What are the different types of cardiovascular diseases?

Cardiovascular diseases (CVD) are a group of diseases affecting the heart and the blood vessels. There are different types and ways in which these diseases can manifest, based on which they are named. Some of the major cardiovascular diseases include:

Atherosclerosis

It forms the base of almost all of the major cardiovascular disease symptoms and complications. Atherosclerosis is the hardening of the arterial walls and their narrowing caused by the buildup of cholesterol and other fats in the form of plaques over their inner walls. If these plaques rupture, they can cause a sudden blockade of the artery by inducing clot formation, thereby cutting off blood supply to the organ concerned.

Coronary Artery disease (CAD)

Coronary arteries are the vessels which are supplying the heart itself. CAD is one of the most common cardiovascular diseases and it occurs because of the atherosclerotic damage to the coronary arteries. So, now the part of the heart which loses its blood supply dies, causing irregularities in the way the heart beats. This presents as a myocardial infarction or a heart attack.

Congenital Heart diseases (CHD)

The term ‘congenital’ refers to any disease that is present at birth itself. These congenital heart diseases include several structural and functional defects in the heart that affect the way in which the heart beats. Though highly fatal, most of these could be corrected by very early diagnosis and surgical correction. These diseases are caused by any factor that affects the development of the heart, especially in the first half of the pregnancy.

Cerebrovascular Disease or Strokes

Like heart attacks, cerebrovascular diseases, and also called strokes are another acute complication arising due to coronary artery disease. Due to artery diseases like atherosclerosis, if the blood supply going to the brain gets interrupted, strokes can occur.

Rheumatic Heart Disease (RHD)

RHD arises as a dangerous complication of Rheumatic fever, which is a bacterial infection caused by Streptococcus bacteria. This bacteria can either cause sore throat complaints or scarlet fever. If these are left untreated, the bacteria can spread to the heart and cause permanent damage to the heart valves. It also can affect other parts of the body like joints, skin or brain. RHD is common between the ages of 5 and 15.

Peripheral Artery Disease / Peripheral Vascular disease (PVD)

This is a disease mainly affecting the blood vessels supplying the limbs. It is caused by the narrowing and hardening of the arteries by deposition of fats and calcium. Smoking is the chief risk factor for this condition. It can cause chronic non-healing ulcers, severe cramping pain, and numbness and may end up needing amputation if not managed early.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

DVT is a dangerous condition in which blood clots are formed within a deeply located vein, especially in the legs. It can happen because of multiple factors like surgery and prolonged bed rest, pregnancy, cancers, birth control pills, leg bone fractures etc. This is extremely dangerous because if these clots break, the little pieces called emboli can travel and block the blood vessels of the lungs (a fatal condition called Pulmonary Embolism).

Arrhythmias

These are rhythm abnormalities of the heart due to various reasons that affect the normal beating of the heart. There are several types of arrhythmias out of which some can be mild and asymptomatic whereas others can be life threatening.

What are the effects of cardiovascular diseases (CVD)?

As already seen, atherosclerosis forms the first step in the majority of cardiovascular diseases. The atherosclerotic lesions can cause blood clots to form (called thrombosis) within the major vessels which can manifest acutely as:

• stroke

• heart attacks

• angina (pain in the chest)

• myocardial infarction (death of the heart tissues)

• ischaemic death of tissues ( due to insufficient blood supply) leading gangrene of limbs which may end up needing amputation or gangrene even of internal organs

In addition, long-standing atherosclerotic damage combined with hypertension can weaken the walls of the major arteries leading to tears in them (arterial dissection) or ballooning out of these arteries (aneurysms). If these dissections or aneurysms rupture, they can lead to severe internal bleeding and death.

What is heart failure?

Heart failure is the endpoint of any cardiovascular disease. It develops when the heart is not able to pump enough blood to fulfill the body’s needs. Heart failure can either develop acutely and slowly and chronically over time based on the underlying causes.

As the right heart is concerned with collecting deoxygenated blood, if there is right heart failure, this oxygen poor blood cannot be received by the failing right heart. So it starts flowing back to the veins at the periphery of the body. Over time, the fluid element of this blood starts leaking via the vein walls into the space around the veins, especially at the ankles, legs, abdomen etc thereby causing their swelling. Ultimately this blood and fluid also collects in the chest cavity, further compressing the lungs and heart, causing a condition called Congestive Heart Failure and finally death.

Cardiovascular disease risk factors

The risk factor profile of cardiovascular disease symptoms is multifactorial. They can be either modifiable risk factors which can be corrected by lifestyle changes and medical assistance or non-modifiable which cannot be corrected.

Non-modifiable risk factors

• Increasing age

• Male sex

• Positive family history

• Genetic factors

• Type A personality

Modifiable risk factors

• Smoking

• Alcohol consumption

• High blood pressure

• Diabetes mellitus

• Elevated blood cholesterol

• Obesity

• Poor physical activity / sedentary lifestyle

• Stressful living

• Intake of oral contraceptive pills

What are the cardiovascular disease symptoms?

There are a multitude of cardiovascular disease symptoms. Different combinations of cardiovascular symptoms can be seen in different heart conditions based on the underlying issue. Some of these major cardiovascular disease symptoms include.

• Palpitations

• Chest pain that could be felt radiating to the jaw, neck, back and arms

• Sweating

• Shortness of breath

• Dizziness or lightheadedness

• Unable to carry out activities of daily life which were easily possible earlier

• Swelling of legs

These are some of the major cardiovascular disease symptoms.

If the patient has undergone stroke, the cardiovascular symptoms could be different:

• Numbness over face or limbs, especially on one side

• Unable to walk or falling down

• Disorientation and altered consciousness

• Difficulty in speech

• Blurring of vision

• Severe headache

• Fainting spells

• Seizures etc. could be seen.

What tests and investigations are needed?

To arrive at a specific diagnosis and to start with the treatment plan, your treating physician may subject you to a few routine tests and a few special tests to estimate the working capacity of your heart.

Routine tests like blood tests to estimate your cholesterol and blood sugar levels, urine tests, ECG and checking of vitals like pulses in different parts of the body and blood pressure may be done.

Further certain special tests may be prescribed based on the need and severity of the condition:

Treadmill test (TMT)

this is a special type of ECG taken while the patient is made to exercise on a treadmill. This helps assess the working of the heart under stress.

Angiogram

it is an invasive study of the heart where a small catheter is channeled through different chambers of the heart to study them

Echocardiogram

This is a special ultrasound scan for the heart which helps to assess the real-time motion of the heart. This is the best test to assess the functioning of the heart valves.

MRI

Specially to study the coverings of the heart and soft tissues around it

Isotope scans

These scans use radioactive isotopes to check whether the heart muscle is receiving adequate blood perfusion.

How are cardiovascular diseases treated?

The treatment plan for heart diseases vary according to the condition and its severity and several other factors. Mild conditions in the beginning stages could be managed just by lifestyle modifications whereas more serious and acute conditions may need immediate surgery or invasive procedures to save the patient.

Lifestyle modifications

• This is the first step in treating cardiovascular diseases. These include regular physical activity, eating a low sugar, salt-restricted and low-fat diet, smoking and alcohol cessation and trying to follow a stress-free lifestyle. Your physician may refer you to a dietician to help tailor a balanced Cardiovascular diet plan just for you.

• Stress can be managed by stretching, breathing exercises, relaxation, meditation, and yoga.

• Aerobic exercise elevates the strength of the heart and its size. Being physically active also enhances the circulatory system by increasing the oxygen-carrying capacity of the blood.

Medical management

If the lifestyle modifications are not enough, your physician may start you on drugs. The combination of drugs may be different for each patient based on their specific clinical picture. Drugs may include anticoagulants or blood thinners, diuretics to avoid any fluid accumulating in the body, cholesterol lowering drugs, drugs to control blood pressure and drugs to help the heart pump better and in a regular fashion. If the patient is diabetic, anti-diabetic drugs may also be included in their daily regimen.

The dosages of these various drugs will be frequently adjusted to maintain the delicate balance between different vital parameters in the body.

Surgical management

• Surgical management of cardiovascular diseases may be needed in advanced conditions or in acutely life-threatening conditions. Few examples are:

• Immediate corrective surgeries may be needed in congenital heart diseases to save the life of the baby

• In serious rhythm abnormalities of the heart where it starts beating irregularly and inadequately, pacemaker implantation surgeries may be performed which help in regulating the rhythm in which the heart has to beat

• Cardiac bypass surgeries may be needed to bypass a narrowed portion of a major vessel due to atherosclerosis

• Angioplasty surgeries are done to open up narrowed or blocked coronary arteries. These procedures could be combined with the placement of a stent made of meshed metal inside the previously narrowed vessels to avoid future blockade.

Can I prevent cardiovascular diseases?

It is absolutely possible to prevent the progression of cardiovascular diseases and reduce the risk of heart attacks by controlling the modifiable risk factors which are also cardiovascular disease causes.

• Quit smoking and alcohol

• Keep your blood pressure and diabetes if present, under control

• Maintain an ideal weight for your height

• Take a healthy balanced diet

• Get regular physical activity

• Try to control stress levels

• Get adequate nighttime sleep

• Consult with a physician immediately if you experience any of the above cardiovascular diseases symptoms

• If diagnosed with a heart disease, sincerely follow the prescribed treatment plan

• Make it known to your close family members and work colleagues that you are a cardiac patient as it may help save valuable moments in case of any medical emergency.

Wishes for a happy and healthy heart! 

Reference:

1. WHO.INT

2. HERT. ORG