What is Cardiovascular Disease (CVD)?
Cardiovascular disease is an umbrella term for diseases that affect the cardiovascular system and circulation. These include high blood pressure (hypertension), coronary artery disease, and vascular dementia which lead to heart attacks, strokes, and angina. These diseases can also impact the heart's electrical conduction and cause arrhythmias, as well as the structure and function of the heart, and can cause heart failure. General symptoms of Cardiovascular Disease include chest pain, shortness of breath, pain and weakness in the arms and legs, dizziness, and fatigue. Some of these diseases can also cause swelling around the legs, an indication of lower cardiac function and heart failure. ​
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Coronary Artery Disease (CAD)
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Coronary artery disease is a condition that affects the coronary arteries or the blood vessels that supply the heart with oxygenated blood to keep the muscle pumping. Coronary arteries that become blocked or narrowed can lead to worsening symptoms and can cause heart attacks, angina pains, and other events. Narrowing and blockages in the arteries can be caused by increased cholesterol levels leading to a condition known as Atherosclerosis. A progression of atherosclerosis leads to damage to the vessel wall or a rupture of the wall which may lead to a blood clot. A blood clot (or thrombus) could potentially lead to a restriction of blood flow to the heart muscle causing a myocardial infarction (MI) otherwise known as a heart attack.
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A thrombus might also break off from the original vessel and move in the blood which is known as an embolus. This might cause a blockage in another area of the heart or could cause a blockage in the lungs (Pulmonary Embolism) or a Stroke (Cerebral Infarction). Controlling cholesterol levels usually requires medication and a controlled diet to eliminate any fats or oils. In the event of narrowing or blocked arteries, other forms of treatment may be required:
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Coronary Angiogram - a Coronary Angiogram is an invasive procedure that looks at the condition of the coronary arteries. This is done by inserting a small tube called a catheter through the wrist or leg, which is then advanced to the Aorta (a large blood vessel that carries blood from the left ventricle to the rest of the body). The coronary arteries of the heart branch off from the aorta, and so the catheter is used to look inside these arteries and assess their condition. Usually, a radioactive dye is used to allow the arteries to be seen on a special type of x-ray, better known as Fluoroscopy.
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Other Procedures and Treatments for Coronary Disease - Treatments and other procedures for CAD will vary depending on the severity of the blockage in the artery. When arteries are narrowed, a procedure known as a balloon angioplasty can be performed which pushes the artery walls open and allows for more blood flow through the vessel. Sometimes there may be a risk of the vessel closing up again or re-narrowing, so a stent may be inserted into the vessel to keep it open in a procedure known as a Percutaneous Coronary Intervention (PCI). These procedures can be done at the same time as a Coronary Angiogram, and are performed using the same method as an Angiogram through a catheter.
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In the event of an artery being completely blocked, a procedure can be performed to bypass the affected artery. This procedure is known as a Coronary Artery Bypass Graft (or CABG for short). You may be required to stay in a hospital for a few days after a CABG procedure, whereas other procedures are usually performed as day-case operations.
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Heart Attack
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A heart attack can occur for several different reasons, but is essentially when the heart muscle is deprived of any blood flow to a portion of the heart muscle, or myocardium. This is why a heart attack is usually referred to as a Myocardial Infarction or MI. The area of heart muscle deprived of blood flow is not able to receive any oxygen from the fresh blood, which means that the myocardium begins to die. This means that the heart muscle will not move or efficiently pump blood, and so will impact the cardiac cycle, conduction systems, and the heart's function. Heart attacks can be treated if detected early and usually require an immediate PCI to the affected vessel, but a prolonged heart attack could lead to hemodynamic compromise and even death if the heart muscle is irreparable.
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Heart attack symptoms can vary from person to person, and are usually different in males and females. Most patients will experience chest pain, shortness of breath, sweating, pain radiating in the jaw, back, or left arm, and sometimes even nausea. In rare occasions, heart attacks can be silent with no preceding symptoms but mostly a patient will collapse which would alert bystanders that they are having a heart attack.
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When diagnosing a heart attack in the hospital, a few tests can be used. Blood tests are always useful as any raised inflammatory markers and cardiac markers can reliably indicate an acute heart attack. An ECG can also be a useful tool to detect a heart attack. The ST segment on the ECG can be a good indicator of myocardial health, and ST elevation can indicate the presence of a recent or ongoing heart attack. A heart attack diagnosed with the use of ST elevation on an ECG is known as a STEMI (ST-Elevation Myocardial Infarction). Non-STEMI heart attacks are known as NSTEMIs.
Further care and Medication - Following a heart attack, a patient might require monitoring for a few days before being discharged from the hospital. Regular medication such as blood thinners, anti-inflammatory medicines such as Aspirin, and cholesterol-controlling medication such as statins might be required on a long-term prescription following a heart attack.
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Sometimes, patients may require rehabilitation sessions to regain strength and cardiac function following a more severe heart attack. It may take a few weeks to return to your normal level of activity following a heart attack, but regular rehabilitation can vastly improve your prognosis and can help you to return to normality.
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Heart Attack
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Blood pressure is a measurement of the pressure at which blood flows through blood vessels. Two numbers are recorded during blood pressure measurements which include a systolic and diastolic reading, with both measurements recorded in millimeters of mercury (mmHg). The systolic reading is the force with which your heart pumps blood under pressure (during systole). The normal reading for systolic pressure is around 120mmHg. Diastolic pressure is measured when the heart is at rest and is measured as the resistance of the blood flow in the vessels between heartbeats. A normal diastolic reading should be around 80mmHg.
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Hypotension - Blood pressure readings lower than 90/60mmHg are known as hypotension (low blood pressure) and can cause symptoms such as dizziness and fatigue. The pressure of blood being pumped is not high enough to keep up with the demand in the heart and can lead to fainting or blackouts, otherwise known as Syncope.
Hypertension - Blood Pressure measurements higher than 140/90mmHg are classed as Hypertensive (high blood pressure). Blood pressure usually rises with age due to the stiffening of the arteries, as well as other co-morbidities such as Diabetes and Hypercholesterolaemia affecting blood vessels. Older people (usually patients above 80) have higher blood pressure criteria of up to 150/90mmHg. ​
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Blood pressure readings above 120/80mmHg, but below 140/90mmHg are considered at risk of developing hypertension but do not usually require medical management.
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Risks of High Blood Pressure - sustained hypertension, or prolonged periods of high blood pressure, could put you at risk of other serious health conditions. These conditions could include:
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• Heart Disease
• Heart Attacks
• Strokes
• Heart Failure
• Peripheral Artery Disease (PAD)
• Aortic Aneurysms
• Kidney Failure
• Vascular Dementia (and other brain injuries)
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Lifestyle choices can always help to manage blood pressure. Increasing exercise, losing weight, reducing stress, avoiding coffee or alcohol and other such measures can help to reduce and manage your blood pressure. There may be some things that you cannot control which contributes to higher blood pressure levels, such as your ethnic background and socioeconomic status. Studies have proven links between low socioeconomic status as well as BAME (Black, Asian, or Minority Ethnicity) backgrounds with higher blood pressure levels.
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Treatment for high blood pressure starts with lifestyle changes in diet in exercise. Your doctor might ask for an ambulatory blood pressure monitor to record measurements throughout the day and calculate an average blood pressure reading.
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If lifestyle changes do not make a difference, then medication can be given to help control blood pressure levels. Different medicines work for different people, and sometimes the first medicine might not always be the most suitable. Medicines will depend on age, ethnicity, and average overall blood pressure levels.
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Angina
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Angina is a centralised chest pain that occurs due to a reduction of blood flow to the heart muscle in arteries becoming narrowed by fatty substances. This is known as Atherosclerosis. Angina is not usually life-threatening but can pose a warning that patients may be at risk of a heart attack or stroke. Symptoms of Angina can be controlled with treatment and lifestyle changes and can ultimately reduce the risk of further issues or co-morbidities.
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Anginal chest pain can feel like a tight squeeze on the chest or a dull ache that does not go away. This feeling may spread to the arms, jaw, and back and sometimes feel like some of the symptoms of a heart attack. Anginal pain is usually triggered by physical activity or stress and normally stops after a few minutes of rest.
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There are usually two main types of Angina, known as Stable and Unstable:
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Stable Angina - Stable angina is more common and is normally associated with triggers such as exercise and stress. Symptoms normally subside after a few minutes of rest.
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Unstable Angina - Unstable Angina is less common but more serious as attacks do not normally have a trigger and are usually unpredictable. Symptoms might continue despite rest and may impact a person's activities. Some people tend to develop unstable angina after having stable angina. Several medications may be needed to control the symptoms of angina depending on their severity.
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Treatment for Angina might include:
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• Medicines to manage the risk of stroke and heart attacks
• Treat attacks when they happen
• Prevent further attacks
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Sometimes medicines and other treatments might not prove to be effective, so other treatment options such as procedures to increase the blood flow to the heart might be performed to reduce the symptoms of Angina.
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Lifestyle changes can make a big difference in symptoms. Changes like a balanced diet, cutting down on alcohol and quitting smoking, losing weight and regular exercise can all help to improve cardiac health and symptoms of Angina. ​​
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A stroke is a serious, life-threatening condition that occurs when the blood supply to a part of the brain is cut off. A stroke requires immediate and urgent treatment to minimise the damage to the brain and allow for a better prognosis following immediate treatment.
The brain requires oxygenated blood to function properly. Any restriction or blockage to the supply of blood to the brain causes brain cells to die, which leads to the loss of brain function. In the long term, a stroke can lead to brain damage, severe disability, and even death if not treated immediately. There are two main types of stroke which occur and impact the blood flow to the brain in different ways. These are:
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• Ischaemic Stroke - This is when blood supply is stopped or reduced because of a blood clot, which accounts for 85% of all strokes. Blood clots are usually formed due to coronary artery disease, with clots formed through the process of atherosclerosis.
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• Haemorrhagic Stroke - this stroke, accounting for less than 15% of all strokes, occurs when blood vessels supplying blood to the brain become weakened and burst or rupture. Blood vessels can be affected by atherosclerosis or can become weaker with age and other co-morbidities such as Diabetes.
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Certain conditions increase the risks of a stroke occurring. Some of these conditions are:
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• High Blood Pressure - this impacts the walls of the blood vessels and weakens them adding increased strain, which can lead to a rupture.
• High Cholesterol - increases the fatty deposits inside the arteries leading to atherosclerosis and plaque build-up which aids in forming a clot
• Atrial Fibrillation - AF means that blood is not pumped properly and so can stagnate in the heart, causing clots to form which can travel to the brain and other organs.
• Diabetes - Diabetes increases the risk of blood vessels becoming brittle and weak, making them stiffer over time which can cause damage and can also burst or cause a rupture.
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Treatments for a stroke depend on the factors that caused the stroke, and the timeline of events that have happened since the stroke. If a stroke has been caused by a blood clot (i.e. Ischaemic strokes), then a procedure known as a thrombolysis will need to be performed to break the clot. Other medications such as blood thinners, cholesterol medication, and blood pressure medicines are also given to reduce the risk of recurrence. Sometimes a clot might need to be surgically removed, or a bleed stopped if the cause of the stroke was Haemorrhagic.
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Some people may need periods of rehabilitation following their stroke to regain their strength and body function. This will vary from person to person depending on the severity of the stroke and further treatment methods. Some people might not recover fully, but they can still regain some strength to perform normal daily tasks. Sometimes, people who have already had a stroke are at higher risk of having another one without any changes to their diet, alcohol intake, and exercise capability. ​​​​​​​
