Cardiovascular diseases are the leading cause of death among young people (25 to 64 years old) in Russia. The main insidiousness of this group of diseases is that they are often asymptomatic, and a person learns that he has heart problems when he can no longer be helped. We talked with the cardiologist of EuroMed Clinic Olga Alexandrovna TSURKAN about which cardiac diseases occur most often, how they manifest themselves, what symptoms are recommended to pay attention to.
The heart is a muscular organ that pumps blood throughout the body. The heart muscle is called the myocardium, and it constantly works - on average, at rest, the heart "pumps" 5 liters of blood per minute, and with intense exercise - more than 15 liters per minute! In order to perform this work effectively, well-coordinated work of the entire system is important: the main muscle (myocardium), atria, ventricles, vessels. The myocardium must be constantly well supplied with nutrients and oxygen. If the work of one of the elements of the system is disrupted or the vessels supplying the heart with blood clog up with cholesterol plaques, cardiac diseases develop.
The most common conditions requiring the help of a cardiologist:
• hypertonic disease,
• coronary artery disease,
• heart failure,
• atrial fibrillation.
• Let's talk about each disease in more detail.
Essential hypertension or arterial hypertension (AH) is a very common condition associated with a chronic increase in blood pressure. This disease can develop as a consequence of some other conditions (secondary hypertension), or by itself (primary hypertension).
Blood pressure is the pressure within the blood vessels-arteries. Blood expelled from the heart (about 60 ml), with one contraction, stretches the aorta and large arterial vessels from the inside. The walls of blood vessels expand under the pressure of blood and then narrow again. The strongest pressure on the blood vessels is recorded when the heart contracts (systole) - this pressure is called systolic pressure. When the heart relaxes (diastole), the blood pressure in the arteries decreases. This pressure is called diastolic pressure.
In a healthy person, systolic blood pressure ranges from 100–140 mm Hg. Art., and diastolic about 70-80 mm Hg. Art. Normally, the pressure figures can fluctuate depending on the person's condition: increase with physical or psycho-emotional stress, decrease during sleep.
The reasons why normal blood pressure is disturbed, in most cases, cannot be established. Certain factors are known that increase a person's risk of developing hypertension. They can be divided into unmodifiable (which we cannot change) and modifiable.
• Age. With age, the walls of large arteries become more rigid, rigid, because of this, the resistance of blood vessels to blood flow increases, therefore, blood pressure rises.
• Hereditary predisposition. The genetic factor is considered to be the main factor in the development of essential hypertension. However, the genes responsible for the onset of this disease have not yet been found.
• Floor. More often men suffer from arterial hypertension.
• excess salt in the diet;
• excessive alcohol consumption;
• abdominal obesity (fat deposition in the abdomen, "beer" belly);
• low physical activity;
• chronic stress;
• increased blood sugar;
• snoring, especially with respiratory arrest;
• change in the lipid (fatty) composition of the blood. The eradication of these "vices" of modern life is the basis for the prevention of not only hypertension, but all cardiovascular diseases in general.
• flashing "flies" before the eyes.
Most often, hypertension is not accompanied by any symptoms and is detected by chance when measuring blood pressure or after the development of its complications, the most dangerous of which is stroke. Therefore, to prevent the development of hypertension, I recommend that you regularly measure your blood pressure, if something is worried - immediately consult a doctor.
Against the background of a sudden increase in blood pressure, a hypertensive crisis may occur. accompanied by pathological changes in the brain and cardiovascular system against the background of vegetative disorders (chills, tremors, sweating, a feeling of rush of blood to the head, a feeling of lack of air, etc.). The level of blood pressure at which clinical manifestations appear is individual (in one patient it is 240/120, in another - 130/90 mm Hg) - it depends on the initial level of blood pressure. If the patient is hypotensive, even a slight increase in blood pressure can cause a clinical picture of a hypertensive crisis.
If a hypertensive crisis is accompanied by intense chest pain, shortness of breath, loss of vision, impaired coordination of movements, vomiting - call an ambulance immediately! Such crises pose a danger to the patient's life and require an immediate reduction in blood pressure in a hospital setting. Complications of a crisis can be myocardial infarction, cardiac arrhythmias, bleeding, strokes, acute encephalopathy, acute renal failure, etc.
IHD is a disease in which the blood supply to the heart muscle is disrupted, as a result of which it lacks oxygen and nutrients. This is usually due to the blockage of the main arteries of the heart with atherosclerotic plaques. Over time, they become more and more, and when the lumen of the vessel overlaps by 60% or more, there is a difficulty in blood flow, oxygen starvation (hypoxia) develops, which leads to myocardial ischemia and the onset of an attack of angina pectoris, as well as to the most dangerous complication of ischemic heart disease - acute myocardial infarction.
Angina pectoris is a temporary, transient failure of the blood supply to the heart muscle (myocardium). An attack of angina pectoris occurs when the lumen of the coronary artery, through which the heart muscle is supplied with oxygen, narrows. With an attack of angina pectoris, pain occurs that has a pressing, compressive or burning character, is localized in the middle of the chest, behind the sternum, gives up (in the neck, lower jaw, teeth) or in the hands. Most often, pain occurs during physical or emotional stress, it passes at rest.
An attack of angina pectoris is a signal that the heart muscle is experiencing a lack of blood supply, the first "bell", which indicates that an urgent need to see a doctor in order to prevent a more dangerous complication, such as acute myocardial infarction.
Acute myocardial infarction is the death of a portion of the heart muscle due to a violation of its blood supply. This can happen due to blockage of the vessel by a thrombus - a blood clot that forms at the site of damage to an atherosclerotic plaque. As a result, blood ceases to flow to the heart muscle, and this leads to myocardial infarction - necrosis, tissue necrosis. Subsequently, a scar forms at this place.
Most often, with myocardial infarction, a person experiences acute pain (burning, pressing) behind the sternum or on both sides of the chest, often the pain radiates to the jaw, neck, back under the shoulder blades, to the upper abdomen. The pain can appear in waves - sometimes intensifying, then weakening. Pain can be accompanied by an irregular heartbeat, weakness, cold sweat, low blood pressure, feeling short of breath, dizziness, fainting, nausea. This state lasts from 20 minutes to several hours. The above symptoms can appear in different combinations, it is not necessary for all signs to be present. In some cases, myocardial infarction can occur without severe pain syndrome, with atypical pain sensations (similar to osteochondrosis or gastric ulcer, for example), and it can also occur without symptoms at all.
It must be remembered that acute myocardial infarction is the most dangerous disease with a high rate of deaths. Therefore, if you suspect a myocardial infarction in yourself or in a loved one, do not delay, urgently call an ambulance.
Heart failure is a pathology in which the heart cannot fully cope with its function, as a result of which other organs and tissues of the body receive less nutrients and oxygen.
Heart failure is expressed as a mismatch between the needs of the body and the capabilities of the heart. Normally, the heart muscle contracts with a certain intensity and "pumps" a large amount of blood. With heart failure, the organ does not cope with its function. Most often, this is expressed by shortness of breath, weakness, edema. At the initial stage of the development of the disease, heart failure manifests itself only with physical exertion - when the heart is forced to work more intensively. At this stage, the disease can still be completely cured, so do not ignore even faint hints of symptoms and see your doctor!
The more the disease is started, the more disturbances in all organs and systems can lead to a prolonged lack of blood supply and nutrients.
Atrial fibrillation (or atrial fibrillation) is a condition in which the rhythm of the heart is disrupted. Normally, the cardiac conduction system produces an impulse that causes the heart to contract at a certain frequency, in a sinus rhythm. With atrial fibrillation, the sinus node stops working, the muscle fibers of the two upper chambers of the heart stop contracting rhythmically, and flutter, tremble or contract uncoordinated. This leads to an irregular heartbeat, and as a result, blood flows unevenly into the chambers of the heart, can accumulate in them, resulting in the formation of blood clots (thrombi). A blood clot can reach the brain through the bloodstream and cause a stroke. Uncontrolled atrial fibrillation increases the risk of stroke by about 5 times!
Atrial fibrillation symptoms: change in heart rate, shortness of breath, chest pain, weakness, dizziness, fainting. Often, with atrial fibrillation, a person does not feel any changes, and the disease is discovered by chance - during a preventive examination.
The number of diagnosed cases of atrial fibrillation is constantly growing. At the same time, new, modern drugs have now appeared that effectively fight this disease. The main thing is to consult a cardiologist in time.
Now they no longer talk about individual diseases. As a rule, diseases of the cardiovascular system are manifested in a complex. It practically does not happen that a person has one thing, only arterial hypertension, for example. This is a single system, and one pulls the other, each cardiac disease increases the risk of developing another.
Resting electrocardiogram (ECG). The ECG measures the heart rate, allows you to assess the condition of the heart muscle and the general condition of the heart. This is usually the so-called screening examination - that is, one that is recommended to be performed regularly prophylactically, even in the absence of complaints. Unfortunately, it is not very informative due to its short-term nature, but we can “catch” the most serious pathological changes with the help of an ECG.
If there are complaints, suspicion of the presence of diseases, it is recommended to perform more detailed, detailed tests.
Exercise ECG (treadmill test). This procedure is a continuous ECG recording and blood pressure monitoring under conditions of a step-by-step dosed load on the treadmill until a submaximal heart rate is reached (200 minus age). This makes it possible to identify possible ischemia (oxygen starvation) of the heart muscle, which is not detected at rest, and to register existing cardiac arrhythmias (most often it is they that lead to sudden death in athletes).
The study is carried out on a specially equipped treadmill. During the treadmill test, walking is actually imitated - a familiar type of load for any person. That is why most researchers consider the treadmill test to be a more physiological method of stress testing. Adhesive electrodes are attached to the chest and distal extremities for ECG recording. With the help of a computer program, the slope of the track is adjusted, due to which the patient is given a certain physical load with a gradual further increase. Walking uphill is simulated. Simultaneously with the ECG, blood pressure is measured at regular intervals.
During the treadmill test, the patient should report the appearance of pain and other unpleasant sensations. The study ends when a certain heart rate is reached, or in connection with a deterioration in the patient's well-being. After the termination of the procedure, the cardiogram and blood pressure readings continue to be recorded for about 10 minutes.
The value of any examination is characterized by the sensitivity and specificity of the method, which are quite high in the load treadmill test: according to various authors, the sensitivity of the treadmill test is 80–85%, the specificity is 83–88%.
The results of the treadmill test allow choosing the most optimal method of treatment - conservative or surgical, assessing the effectiveness of therapy, giving recommendations on household and professional physical activity, and drawing up rehabilitation and training programs.
This examination is a continuous recording of the heart's work on an ECG throughout the day - using a special portable device that is attached to the patient. During the study, the patient is advised to lead a normal life - for the most accurate result.
The holter is a small device that is attached to the patient's belt, the sensors are attached to the chest. The procedure itself is automated, the patient does not need to do anything with the device. During Holter monitoring, the patient keeps a diary of activity and rest, notes his health. After the device is removed, the data from the device and from the patient's diary are entered into a special program, in which this information is analyzed and the daily cardiogram is displayed.
Daily monitoring allows you to track the dynamics of the human heart for a longer time than with a conventional ECG or blood pressure measurement. As a result, we get a much more complete and reliable picture.
24-hour blood pressure monitoring (ABPM).
ABPM is an automatic measurement of blood pressure during the day or more (if necessary) at regular intervals, according to a given program (usually every 15 minutes during the day and 30 minutes at night). A blood pressure cuff is put on the patient's shoulder, connected to a portable monitor of a small size and weight (about 200 grams), which the patient wears on a belt. Measurements are performed on an outpatient basis, under conditions of normal patient activity. The system provides automatic measurement of the pulse, systolic and diastolic blood pressure at set time intervals, on the basis of which the average daily blood pressure and pulse in the day and night periods are calculated, the degree of the night decrease and morning increase in blood pressure, the response to physical activity and psycho-emotional stress is determined, the degree and duration of hypertensive load on target organs, variability of pressure and pulse during the day, episodes of hypotension are revealed. For a more accurate assessment, the patient is asked to keep a diary in which he describes his state of health and complaints during the examination, his activities, physical activity, indicates the time of taking medications, notes the time of sleep and awakening. The only limitation for the patient during the ABPM is the need to relax the hand on which the measurement is taken for more accurate registration.
The technique is simple, painless and very informative. It increases the accuracy of assessing the true level of blood pressure, especially in case of suspicion of the presence of an initial, unstable arterial hypertension.
Ultrasound of the heart. During the examination, the doctor can assess the structural features of the heart, the state of the chambers and valves of the heart, the aorta, the size of the cardiac cavities and the magnitude of the pressure in them, the thickness of the walls of the heart, the thickness of the myocardium, the contractility of the heart muscle, the rate of intracardiac blood flow.
Ultrasound of the vessels of the head and neck is a screening examination for the presence of atherosclerotic changes in the walls of arterial vessels. Ultrasound will clarify the condition of the arteries and veins that feed the brain, which will make it possible to draw conclusions about the risk of developing cardiovascular catastrophes, as well as see problems in the blood supply to the brain, neck, head and spine.
Especially vascular ultrasound is recommended for men over 40 years old - unfortunately, this category of patients often has changes in the state of the vessels, which can be determined thanks to this study.
A cardiologist may recommend testing for cholesterol, glucose, and uric acid.
These indicators reflect the state of metabolism in the body: fat, protein, carbohydrate. A deviation from the norm for these indicators may indicate an increased risk of stroke, heart attack.
First of all, the pressure level. An increase in pressure is always a sign that you need to see a doctor. Signs such as headaches, redness of the skin, tinnitus, dizziness can indirectly indicate high blood pressure.
Chest pain, especially - associated with walking, with physical exertion. Also, chest pain can appear with increased pressure, with stress. Such pains most likely indicate heart disease. The pain syndrome can be either permanent or appear only with exertion, and subside at rest.
Shortness of breath is another fairly common symptom of heart problems.
It is important to understand that heart disease is often asymptomatic or mild. And with age, the risk of their development increases significantly. Therefore, any man over 40 years old and a woman over 50 years old should regularly visit a cardiologist prophylactically. Come at least once a year, perform an EKG, see if everything is in order.
Most heart diseases, "caught" at the initial stage, are successfully treated. The contrast between how easy the prevention of cardiovascular diseases is and how severe the consequences they can have is simply striking!
Pregnant women who are registered at the antenatal clinic are referred for an ECG several times during pregnancy, and it is also often recommended to consult a cardiologist. In addition, blood pressure is monitored at each doctor's visit. What is the reason for this?
Pregnancy is always stressful for the body. During pregnancy, the load on the entire body and, in particular, on the heart increases. The volume of circulating blood increases, the heart rate increases. This can provoke the development of hypertension, heart defects, rhythm disturbances. Therefore, it is important to constantly monitor the woman's condition in order to stop the disease in time, to prevent the development of serious complications.
It often happens that these conditions appear during pregnancy, and disappear after childbirth.
There is an officially approved maximum upper limit for blood pressure: 140/90 mm Hg. Art. - this is the border, after which hypertension is already placed.
But there is a widespread myth among the people that there is a so-called working pressure - it may be above this limit, but it is believed that if a person feels good, then it's okay, there is no need to be treated. This is a dangerous delusion!
Extrasystole is a type of heart rhythm disorder. Quite a few people are given extrasystole on the ECG, this violation is quite common. How serious this is, only a doctor can determine. Most likely, if you have been diagnosed with extrasystole, this is not a reason for panic, even an absolutely healthy heart can give such a rhythm disturbance. But it is important that such arrhythmia can be provoked by serious heart disease, that is, in this case, extrasystole will be one of the symptoms. That is why it is not necessary to ignore such "findings" and it is imperative to be examined by a cardiologist.
The risk of complications in hypertension is equally high whether you experience unpleasant symptoms or not! Yes, hypertension is often asymptomatic. But the risks of hypertensive crisis, stroke, heart attack, etc. remain. Therefore, the main indicator for prescribing treatment is the results of measuring blood pressure, and not the patient's well-being. High blood pressure must always be reduced - this is the only way to avoid complications and serious consequences of hypertension.
Another common misconception is that blood pressure medications cannot be taken continuously, but only during episodes of high blood pressure. This is not true. Arterial hypertension is a chronic disease. And in order for the patient's condition to remain stable, medications must be taken as prescribed by the doctor - regularly. Agree, this is not such a big price for well-being and a decrease in the risk of stroke and other complications - take a pill once a day!