Cardiovascular diseases are a group of organic and functional pathologies of the circulatory system (heart, arteries, veins). Cardiac disorders can be suspected by pain and a feeling of heaviness behind the sternum, shortness of breath, uneven heart rhythm, and rapid heartbeat. With damage to the vessels of the head and neck, headaches, tinnitus, fainting can be observed. Peripheral vascular disease is accompanied by pain in the legs, swelling, lameness. Most CVDs are extremely life-threatening, and if symptoms appear, you should immediately contact a cardiologist or a general practitioner – he will refer you to the right specialist.
Cardiovascular (cardiovascular) diseases are a serious public health problem worldwide due to their high prevalence and high mortality rate. In the world, about a third of all deaths occur from diseases of the circulatory system (85% of them due to heart attack or stroke), more than 75% occur in countries with low and medium levels of economic development. In Russia, the incidence of CVD is more than 19% in the structure of all diseases, mortality is 50%. Experts from the World Health Organization (WHO) predict a further increase in morbidity and mortality from CVD.
People of retirement age are more susceptible to vascular and heart diseases, however, over the past decades, these diseases have become significantly “younger”. Thus, coronary heart disease is often diagnosed for the first time in thirty-year-olds, and from the age of forty, it becomes the cause of premature death. Morbidity statistics show that morbidity and mortality from cardiovascular pathologies are 1.5 times higher in men than in women.
The most common, socially significant CVD include:
- Hypertension is a persistent increase in blood pressure.
- Atherosclerosis – overlapping of the arterial lumen with cholesterol plaques. The defeat of the coronary vessels leads to ischemic heart disease, the arteries of the head and neck – to ischemia (lack of blood supply) to the brain, large arteries of the legs – to limb ischemia.
- Ischemic heart disease is a violation of the blood supply to the myocardium, due to obstruction (narrowing of the lumen) of the coronary arteries. The acute form of the disease is myocardial infarction.
- Cardiac arrhythmias are disorders of the heart rhythm and conduction.
- Inflammatory heart disease – lesions of an autoimmune or infectious nature, affecting the pericardial sac, muscle layer, or internal connective tissue lining of the heart – pericarditis, myocarditis, endocarditis, respectively. The most common is rheumatic heart disease.
- Cerebrovascular pathologies are diseases of the vessels of the brain. An acute form of circulatory disorder in the main vessels of the head and neck is an ischemic stroke (cerebral infarction). In case of violation of the integrity or insolvency of the vascular wall, a hemorrhagic stroke develops (bleeding into the brain).
- Thromboangiitis obliterans is a progressive closure of the small arteries of the legs (first due to spasm, then due to thrombosis), accompanied by limb ischemia.
- Venous thrombosis and pulmonary embolism (PE) – complete or partial closure of a blood clot of the lumen of the veins or the main artery responsible for the blood supply to the lungs.
Much less common:
- congenital and acquired heart defects;
- heart tumors;
- systemic vasculitis;
- thromboembolism of the arteries of the systemic circulation (peripheral, mesenteric, and others).
Reasons for the development of CVD
Damage to the heart and blood vessels are multifactorial pathologies – they occur against the background of several predisposing conditions. The main cause of the vast majority of cardiac and cerebrovascular pathologies is an increase in the level of low-density lipoprotein (LDL) in the blood. An increase in their concentration leads to an excess of cholesterol, which forms plaques on the walls of blood vessels, narrowing their lumen.
An important role in the development of CVD is played by hereditary predisposition – at risk are persons whose closest relatives (brothers, sisters, parents) have the corresponding disease. The likelihood of developing cardiovascular pathologies increases diabetes mellitus, kidney and thyroid diseases, infections (most often streptococcal – tonsillitis, scarlet fever, erysipelas, impetigo). In women, conditions accompanied by hormonal changes become a triggering factor: more often – menopause, less often – pregnancy.
Leading risk factors include lifestyle habits and their adverse effects:
- Physical inactivity. A sedentary lifestyle negatively affects the condition of the vascular walls and myocardium, increases the risk of thrombosis, contributes to the emergence of excess weight, diabetes.
- Diet errors. Increased salt intake increases the risk of hypertension, an excess of sweets in the diet leads to diabetes, obesity, and increases LDL levels. The abuse of animal fats contributes to the development of atherosclerosis. The lack of proteins, microelements (potassium, magnesium, iron, copper, zinc, selenium), most vitamins negatively affect the state of blood vessels and the heart, myocardial function.
- Psycho-emotional stress. Acute stress is accompanied by the release of adrenaline, which increases the workload on the heart, and can lead to myocardial infarction. Chronic stress is accompanied by increased levels of cortisol, which slows down the production of growth hormones. The deficiency of this hormone in adults indirectly provokes the development of CVD.
- Excess body weight is usually a consequence of the influence of the factors listed above. Obesity is a favorable condition for the occurrence of thromboembolism, contributes to an increase in LDL levels, and creates an additional burden on the heart and blood vessels.
- Bad habits. Each episode of alcohol abuse leads to a decrease in the contractile function of the myocardium, disrupts blood circulation. Tobacco smoking leads to an increase in blood pressure, provokes thrombosis, the formation of atherosclerotic plaques, and increases the risk of arrhythmias.
Often, one primary CVD leads to the development of another. So, atherosclerosis and arterial hypertension are the main causes of coronary heart disease, rheumatic heart disease often leads to acquired defects, cardiac arrhythmias, and heart rhythm disturbances to thromboembolism of the arteries supplying blood to the limbs and internal organs.
Symptoms of cardiovascular disease
Diseases of the heart and blood vessels in the initial stages are often asymptomatic and can manifest acutely – manifestations of a heart attack or stroke. The debut (or exacerbation of a chronic pathology) is often preceded by a nervous shock, overwork, physical exertion, and overeating. Most cardiac pathologies are accompanied by heart failure.
Symptoms of heart disease:
- Acute heart failure – cold sweat, a sharp decline in strength, severe choking, coughing with foam (a sign of pulmonary edema), cyanosis of the skin (cyanosis)
- Chronic heart failure – fatigue, poor exercise tolerance, shortness of breath, dyspnea, dry cough (sometimes hemoptysis), scanty urination, edema, ascites.
- Myocardial infarction – acute chest pain radiating to the left shoulder, upper back, neck, chin (sometimes intense pain in the abdomen); shortness of breath, severe weakness, cold sweat; feeling of anxiety, fear of death.
- Rheumatic heart disease – excessive sweating, fever, signs of heart failure.
- Cardiac arrhythmia – palpitations, a feeling of “fading” of the heart, dizziness, fainting, manifestations of heart failure.
Signs of vascular pathologies:
- Arterial hypertension – heaviness, pain, pulsation in the back of the head; lethargy, dizziness, tinnitus, nausea; feeling of “flies” before the eyes.
- Stroke – can begin gradually, with a weakening of muscle tone, numbness of certain areas of the face, limbs. Then lethargy and loss of sensitivity increase to paresis, the affected areas expand. Hearing, vision, speech, and motor coordination disorders may develop. Cerebral symptoms – nausea, vomiting, confusion, coma.
- Chronic cerebrovascular accident – seizures (transient ischemic attacks) are accompanied by more pronounced signs of arterial hypertension, transient speech, hearing, vision, memory disorders, unsteady gait, fainting. Symptoms disappear within a day.
- Pathologies of the peripheral arteries, accompanied by ischemia (thromboembolism, thromboangiitis obliterans, and atherosclerosis) – acute, unbearable pain, transient lameness, dry skin, a change in its shade (pale at first, purple as it progresses), the appearance of poorly healing ulcers.
- Deep vein thrombosis – a feeling of aching pain in the affected limb, swelling, cyanosis of the skin, visible vascular network.
- PE – can combine signs of heart failure, stroke. Other symptoms are fever, pain in the right hypochondrium, skin rashes.
Acute CVD requires emergency medical care, intensive care. If you suspect these pathologies, you should immediately call an ambulance.
Complications of CVD
According to WHO, cardiovascular pathologies are the main cause of death, often leading to disability. A lethal outcome is not uncommon with extensive heart attacks and strokes, massive pulmonary embolism, heart failure complicated by pulmonary edema, cardiogenic shock. A stroke can lead to a wide range of neurological disorders, chronic cerebrovascular accidents – to progressive cognitive impairment. Peripheral arterial pathologies are dangerous for the development of gangrene followed by amputation of the limb (often at a young age). CVD adversely affects the state of the reproductive sphere: impotence is often recorded in men, infertility, and childlessness in women.
The diagnosis of pathology of the heart or blood vessels is established based on the results of a clinical examination, a patient interview, several instrumental and laboratory studies. The main instrumental methods used in the diagnosis of CVD:
- Electrocardiography (ECG) is an electrophysiological method used in the diagnosis of arrhythmias, myocardial infarction. A variation is Holter monitoring, which allows you to take readings during the day using a portable device.
- Echocardiography (EchoCG) – an ultrasound method for examining the heart, reveals both functional disorders and structural disorders (tumors, vegetations, defects, inflammations). It is also prescribed for suspected PE.
- MRI, CT (magnetic resonance, computed tomography) of the brain – used in the diagnosis of strokes.
- Ultrasound and ultrasound (ultrasound duplex scanning and dopplerography) of blood vessels – are used in the diagnosis of chronic cerebrovascular accident, peripheral vascular disease.
Laboratory tests include:
- In the diagnosis of inflammatory heart diseases – a biochemical study of the protein spectrum, a complete blood count, a bacterial blood culture.
- In the diagnosis of atherosclerosis – a biochemical test of cholesterol, LDL, triglycerides.
- If any CVD is suspected – a coagulogram.
Modern equipment allows for diagnostics without invasive procedures.
Depending on the type of pathology, treatment is carried out under the guidance of a cardiologist, neurologist, vascular surgeon, neurosurgeon, cardiac surgeon, phlebologist, rheumatologist. Emergency conditions require the help of a resuscitator. There are conservative and surgical methods for the treatment of CVD.
Conservative methods include:
- drug therapy – drugs are prescribed depending on the diagnosis;
- plasmapheresis, autohemotransfusion – in the treatment of rheumatic heart disease;
- thrombolysis – the dissolution of a blood clot in arterial embolism;
- physiotherapy – in the treatment of chronic cerebrovascular disorders, thromboangiitis obliterans.
Surgical methods for the treatment of CVD:
- thromboembolectomy – surgical removal of a thrombus in case of ineffectiveness or contraindications to thrombolysis;
- thrombectomy – with deep vein thrombosis;
- stenting of peripheral vessels and coronary arteries – in atherosclerosis,
- prosthetic heart valves – with endocarditis;
- stereotaxic aspiration of hematoma – in hemorrhagic stroke.
Today, open surgical interventions are rarely performed, preference is given to vascular surgery – this contributes to the speedy recovery of the patient, minimizing postoperative complications. Nevertheless, after treatment of severe CVD, patients most often need long-term rehabilitation.
The primary prevention of the disease is to prevent it, the secondary is aimed at preventing complications, exacerbations of relapses with an existing pathology. The primary prevention of cardiovascular diseases primarily depends on the patient and consists in revising the lifestyle – to stay healthy, you need to provide a balanced diet, give up bad habits, get rid of excess weight, move more.
Doctors’ recommendations for CVD in the framework of secondary prevention:
- healthy lifestyle;
- treatment of concomitant diseases – control of blood glucose levels in diabetes mellitus, normalization of the concentration of thyroid hormones in case of disorders of its function;
- maintaining normal blood pressure;
- lifelong intake of aspirin (to reduce blood viscosity and prevent thromboembolic complications), statins (to prevent atherosclerosis).