Medical Specialties

Cardiovascular risk. Atherosclerosis.

“My parents died from a heart attack and I worry about my high cholesterol. Am I at risk of also having a heart attack?”.

Why is important to know your Cardiovascular Risk?

Cardiovascular diseases (CVD) are the leading cause of mortality in the adult population. We refer to those diseases related to the heart and arteries of the body. The main ones are coronary heart disease and cerebrovascular disease.

Preventive measures have managed to reduced overall mortality of CVD. It is, therefore, important to identify people who are at risk for cardiovascular events early in order to establish therapies that help reduce potential risk.

How does cardiovascular disease begins?

Cardiovascular disease begins with Atherosclerosis. It is the formation of fatty plaques in the arterial wall (plaques) that favour an inner progressive obstruction of the arteries. When the obstruction is important, symptoms such as angina and diseases like myocardial infarction may occur. Also, if the obstruction affects the cerebral arterial tree, stroke may happen n the form of cerbral embolism or cerebral infarct.

This inflammatory process starts at a young age and can go on for decades without developing symptoms. We do not know when our arteries begin to be affected or when the thrombus develops to occlude the arteries. Therefore, we recommend to perform a cardiovascular screening to identify those at risk of future cardiovascular problems.

What promotes atherosclerosis?

The cardiovascular risk factors favour Atherosclerosis. Its continuous effect weakens the arterial wall and facilitate the entry of cholesterol within the arterial wall to form plaques. The major coronary risk factors are:

• Not Modifiable factors: age and genetics
• Modifiable factors: smoking, cholesterol, hypertension, diabetes mellitus, physical inactivity, obesity and stress.

Acute myocardial infarction / Angina

“I was sleeping peacefully. I was awakened by intense chest pain and breathlessness. I had intense sweating and nausea. I thought I was dying. Promptly, we called an ambulance. It was a myocardial infarction. Immediate treatment saved my life.”

How to coronary disease appears?

The accumulation of cholesterol deposits on the arterial wall produces an inflammatory process that leads toplaque formation. Over time, these plaques can penetrate into the coronary artery wall and cause a progressive obstruction of the lumen which leads to a lack of blood supply to the heart muscle.

• When the obstruction is complete and causes cell death, then we talk about Infarction.
• When the obstruction is partial, angina can happen.

What are the coronary risk factors?

• Non-modifiable factors: age and genetics
• Modifiable factors: smoking, high cholesterol, hypertension, diabetes mellitus, physical inactivity, obesity and stress

What are the symptoms?

It usually appears as a central chest pain, at the sternum level, usually intense, oppressive in nature and associated with nausea or vomiting. The pain may radiate or be reflected to the left arm, base of the neck, jaw, wrists or dorsal region. However, sometimes it may be in other locations and associated with several symptoms, such as breathlessness, palpitations or dizziness. In myocardial infarction, the pain can last for several hours while in angina usually lasts for a few minutes.

For your benefit, ask for a doctor advice as soon as you feel any alarm symptoms.

Arrythmias.

“Doctor, I have palpitations, I can feel my heart thumping …” The heartbeat is generated in the right atrium and through conductive fibres, the electrical impulses stimulate cells of the atria and ventricles. The loss of regular heartbeat rhythm is what we call arrhythmias.

Why arrhythmias occur?

• Extrinsic factors: those that excite the cardiac cells and promote the stimulation of electrical impulses. These include: stress, stimulants (like caffeine, cocaine), hormones (like thyroid disorders), drugs (like respiratory inhalers).
• Intrinsic factors: produced by structural abnormalities of heart muscle secondary to hypertension, myocardial infarction, cardiomyopathies, etc.

What types of arrhythmias occur?

Are classified according to:

1. Origin: atrial or ventricular arrythmias
2. Heart rate: bradycardia (slow) or tachycardia (fast)
3. Regular or irregular
4. Persistence: in paroxysmal (temporary) or chronic (permanent)

What symptoms occur?

Many arrhythmias may occur without symptoms and go unnoticed. They are detected when performing a medical examination or electrocardiogram (ECG). At other times, they may be accompanied by symptoms such as palpitations, fatigue, chest pain, breathlessness or dizziness.

It would be advisable to seek a medical opinion if symptoms occur.

Syncope / Fainting

“The phone woke me up from a nap. I stood up abruptly to answer it. I felt dizzy and my head turning, then I fell down suddenly. I woke up in a short time, the phone kept ringing, my head was hurting from the fall.”

What is syncope?

A Syncope or fainting is a loss of consciousness with an spontaneous recovery within a few seconds or minutes. It can present with early symptoms such as dizziness or appear abruptly and present with trauma.

What are the causes and symptoms of syncope?

• Cardiac syncope: tachyarrhythmias, transient heart block, heart valve disease, cardiomyopathies. They usually appear associated with chest pain and / or palpitations and / or on physical effort.
• Neurological syncope: stroke, intracranial hemorrhage and epilepsy. Suggestive signs are seizures, sphincter relaxation or symptoms of stroke (one-sided weakness, slurred speech).
• Vasovagal syncope: usually the most common and caused by severe reductions in blood pressure. Sometimes, they can be triggered in some situations such as blood sample extraction, severe pain (eg renal colic), hot environments (eg underground, concerts …). It usually present with dizziness, cold sweats, skin pallor and loss of vision.

Valvular Heart disease

“A few years ago, in a school medical review, I was detected a heart murmur. It was a congenital valve disease. Since then, I have had regular cardiac tests, with no complications. But two weeks ago, I was told that the valve does not close properly and it would be necessary to have heart valve surgery before symptoms appear”. The heart consists of four chambers (two atria and 2 ventricles) that communicate with each other through the heart valves. Valve opening allows the passage of blood from a heart chamber to another and closing the seal between chambers during the cardiac cycle.

The heart has 4 valves:

• Aortic valve: separates the left ventricle from the aorta.
• Mitral valve: separates the atrium and the left ventricle.
• Tricuspid valve: separating the atrium from the right ventricle.
• Pulmonary valve: separates the right ventricle from the pulmonary artery.

We refer to:

• Valvular stenosis: when there is an obstruction to blood flow between cavities.
• Valvular insufficiency: when there is an incomplete closure of the valve with backflow of blood from one cavity to another.

Causes:

Heart valves can be affected by congenital problems, rheumatic heart disease, trauma, infections and aging (degenerative). Currently, the most common cause is degenerative, typical in the elderly that causes hardening sclerosis and calcification of valves.

Also, there are murmurs of functional type that do not involve structural valve disorder. These are usually temporary and related to intercurrent conditions such as anemia or tachycardia.

Depending on the degree of severity, they can be classified in:

• Minimal heart valve disease: requires no treatment, only medical monitoring.
• Moderate heart valve disease: it requires a regular control, association with medical treatment and, sometimes, valvular heart surgery.
• Severe heart valve disease: despite being asymptomatic, it requires surgical treatment considered as prosthetic valve repair or valve replacement.

Heart Failure.

“After suffering a heart attack I was unable to breathe, I got tired, my feet swell. At night, I could not sleep well, I had to sit in a chair and opened the window to breathe easier … It was a terrible feeling …”.

What is heart failure?

The progressive deterioration in heart contractility will lead to a limitation of pumped blood volumen necessary for the rest of the body. It occurs because of a structural or functional abnormalities affecting the heart. Depending on the affected cavity , we can talk about left or right-sided heart failure.

What are the causes?

The most common causes are usually due to hypertension, myocardial infarction, cardiomyopathy, valvular heart disease, myocarditis or arrhythmias.

What symptoms are associated with heart failure?

• The left-sided heart failure can cause cough and breathlessness that appears on exertion.
• Right-sided heart failure is characterized by fluid retention, detectable by weight gain, increased abdominal girth and edema or swollen ankles.

Sudden death in athletes.

“The sudden death of an athlete was recently seen during a football game. Is sport harmful?”. Exercise is beneficial to health. The problem is the large impact that television broadcasting of an elite athlete, considered the paradigm of health and fitness, collapsing following a sudden death. But its incidence is low (1-2 per 100,000 athletes).

The most frequent causes of sudden death in athletes are related to secondary malignant cardiac arrhythmias. In young atheletes, it is related to congenital heart disease and in those over 35 year of age, obstructive coronary disease.

Can it be prevented?

It would be helpful to have information about their cardiovascular condition before undergoing intense physical training. That’s important:

• To exclude any exercise-related symptoms (eg, syncope, chest pain, palpitations).
• To assess family history of sudden death or syncope.
• To request a excercise test. Sports federations consider it a mandatory cardiological test.
• To have Heart anatomical information. A simple cardiac echocardiography can identify congenital cardiac pathologies exclusive for competitive sport.

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