We are at your service to prevent, diagnose and treat several cardiovascular pathologies or symptoms.
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.
How is coronary artery disease diagnosed?
We have various diagnostic tools for the interpretation of symptoms:
- Electrocardiogram identifies potential indirect signs of ischaemic heart disease.
- Analysis of blood markers of heart muscle injury.
- Colour Doppler echocardiographyr: displays abnormalities of cardiac muscle contractility and quantifies the deterioration of contractile function after a heart attack.
- Stress test or exercise testing: reveals changes in the electrocardiogram (ECG) induced by increasing oxygen consumption during exertion. Theses changes may be suggestive of coronary obstruction.
- Coronary CT scan: displays coronary arteries anatomy and can identify obstructions and stenosis of those arteries.
- Heart MRI scan: quantifies the degree of scar infarction and coronary blood flow. It can analyze with high precision the morphology and contractile ability of the heart muscle.
- Cardiac catheterization and coronary angiography: invasive test to evaluate coronary anatomy and to analyze the number, location and degree of obstruction of your coronary lesions.
What types of treatments are available?
Depending on the diagnosis, you will be advised to follow:
- Interventional treatment by angioplasty and / or coronary stent.
- Surgical treatment through coronary artery by-pass graft.
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:
- Origin: atrial or ventricular arrythmias
- Heart rate: bradycardia (slow) or tachycardia (fast)
- Regular or irregular
- 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.
How are arrhythmias diagnosed?
There are several diagnostic methods:
- The electrocardiogram (ECG) records the electrical activity of the heart. It is the reference test, but has the disadvantage that only evaluates the time of scanning.
- Ambulatory ECG recording (Holter). It records cardiac activity during a 24 hours period. It is used for the study of short lived episodes of palpitations which are not detected by ECG.
- The stress test or exercise testing allows the study of palpitations related to physical activity.
- Electrophysiological study is an invasive test that studies arrhythmias through intracardiac recording obtained with a catheter. It is used when palpitations are very symptomatic and not detectable by the usual mechanisms.
- Implantable subcutaneous Holter device allows registration for several months or years. It is indicated when palpitations are rare.
What treatments can be done?
Depending on the type of arrhythmias, several treatments can be indicated:
- Antiarrhythmic drugs. They allow heart rate control and / or the reversal of an acute tachycardia.
- Anticoagulant drugs are indicated in the treatment of arrhythmias with an associated embolic potential, like atrial fibrillation.
- Radiofrequency Ablation is an invasive test applying thermal energy through a catheter to allow permanent elimination of arrhythmogenic focus in certain tachycardias.
- Pacemaker implantation. Implantable device that delivers electrical impulses to treat bradyarrhythmias or several degrees of heart conduction blocks.
- Implantation of implantable defibrillator. Subcutaneous device that delivers electric shocks to reverse ventricular arrhythmias in extreme situations.
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.
What diagnostic tests can be ordered?
- Color Doppler echocardiography
- Holter electrocardiogram 24 hours
- Cranial CT
- Electrophysiological Study
- Tilting Table Test
What treatment is applied?
It is defined in terms of the cause of syncope:
- The vasovagal syncope is usually controlled with physical measures, such as compression stocking, and dietary measures such as salt intake. However, sometimes when they are very frequent, we recommend adding pharmacological measures.
- The cardiac syncope usually requires an active intervention, like drug therapy, implantation of devices (pacemakers, coronary stents, etc.) and / or cardiac surgery (by coronary bypass, valve replacement.)
- The neurological syncope usually requires pharmacological treatment (antiepileptic, oral anticoagulant drugs etc.) or interventional (catheters and / or surgery).
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.
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.
- Physical examination shows the presence of a murmur on cardiac auscultation.
- Electrocardiogram can show signs of abnormal cardiac chambers, associated with valve involvement.
- Transthoracic Doppler Echocardiography: it is a routine technique most commonly used to assess the morphology and function of the heart valves.
- Transesophageal ultrasound: images obtained by a tube inserted through the esophagus. It will allow to assess valves with better definition. It is useful in suspected infected heart valves and intracardiac masses.
- Cardiac Magnetic Resonance offers an anatomical and functional detail of the valves. It is very useful for the study of intracardiac masses.
- Valve repair represents the surgical reconstruction of the valve.
- Valve Replacement involves replacing the valve with a biological or mechanical prosthesis. It is usually done surgically but when the surgical risk is high, it can be replaced through cardiac catheterization.
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.
How is heart failure diagnosed?
- Physical examination and cardiac auscultation are necessary..
- Chest x-ray will show signs of pulmonary congestion.
- Electrocardiogram can show the presence of arrhythmias, heart enlargement, or sings of myocardial infarction
- Colour Doppler echocardiography describes the abnormalities in the heart muscle, valvular function and quantification of cardiac function.
- Heart MRI is an excellent technique to asses cardiac anatomy and function.
- Cardiac catheterization analyzes the number and degree of coronary obstruction in patients with myocardial infarction or unstable angina.
What is the treatment of heart failure?
- Physical measures can be used such as limitations of salt intake and fluids.
- Pharmacological treatment.
- Interventional treatment: cardiac catheterization (angioplasty) and coronary artery by pass graft
- Resynchronization pacemaker implantation: synchronous stimulation between heart chambers that optimizes the overall contraction.
- Heart transplantation: irreversible situations.
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.