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Arterial hypertension is a risk factor for coronary artery disease and heart failure. Its early diagnosis and adequate treatment significantly reduce the incidence of stroke, acute myocardial infarction and heart failure. It should be noted that arterial hypertension usually causes no symptoms. Therefore it is important to be checked regularly. There is a broad spectrum of pharmaceutical agents that can be used to effectively lower blood pressure to the normal range. Those agents should be tailored to the needs and specificity of each patient. Finally, it should be emphasized that regular physical activity, weight reduction, smoking cessation and healthy nutrition have a beneficial effect on blood pressure control.
Dyslipidemia is the term used to describe an abnormally high amount of lipids in the blood. Lipids in general are very important for the normal function at the cellular level of an organism. However, when “bad cholesterol levels” climb up, then unavoidably they tend to accumulate at the artery walls causing narrowing or obstruction of the vessels. It is imperative to say that in general a healthy lifestyle is of paramount importance in maintaining a normal lipid profile. However, in some individuals with abnormally high levels of cholesterol that does not improve with lifestyle modifications, and also in those with the existence of other risk factors, a more aggressive treatment management of dyslipidemia is warranted. The most common and effective medication that improves lipid profile is statin. In fact, it is now documented with scientific research that the use of statins is associated with a significantly reduced risk of myocardial infarction and stroke.
Coronary artery disease is now confirmed to be the most common cause of death in developed countries. It is in part attributed to the accumulation of lipids and fat along with fibrous tissue in the wall of arteries that supply blood to the heart. It may present clinically as acute myocardial infarction, stable or unstable angina. Unfortunately, it can sometimes initially present with sudden death without any warning symptoms. It is also possible, especially in elderly patients and diabetics an acute myocardial infarction to develop without symptoms (“silent myocardial infarction”). It is only noted after the patient develops symptoms of heart failure (fatigue and shortness of breath).
Angina is the most prominent symptom of coronary artery disease and is the pain produced due to insufficient oxygen supply to the heart. It is very important for one to know the special features of this pain in order to timely ask for medical attention. Most patients describe angina as “chest tightness” or “burning sensation”. Angina is developed in conditions of increased workload (eg. when climbing stairs). The pain is located most often in the center of the chest, lasts a few minutes and resolves with rest.
Atrial fibrillation is the most common arrhythmia and it usually presents to individuals older than 60 years of age and those with arterial hypertension. Some may notice the “irregular heart beating”, while others may not. Atrial fibrillation may be permanent or paroxysmal. It is very important for these individuals to be evaluated by a specialist, because this arrhythmia substantially increases the risk of embolic stroke. Fortunately, there are medications which can control the arrhythmia and minimize the risk of stroke. In young individuals with the paroxysmal form of atrial fibrillation that does not optimally respond to medical therapy it is possible to attempt ablation. Ablation is an invasive procedure for permanent destruction of the origin of the arrhythmia and it should be performed in carefully selected patients.
Heart failure is the clinical syndrome which occurs when the heart is not able to pump enough blood to cover an individual’s needs. Heart failure may be caused by coronary artery disease (prior myocardial infarction), inadequately controlled blood pressure and overconsumption of alcohol. An environmental trigger (viral infection) in addition to a genetic predisposition can sometimes cause heart failure. The most prominent symptoms are fatigue, dyspnea on effort and fluid retention, which is usually evident as ankle swelling. When such symptoms are noted prompt evaluation by a cardiologist is mandatory so that heart failure is diagnosed at an early stage. There is a broad range of pharmaceutical agents that are able to improve both prognosis in such patients, and also quality of life.
Cardiac function is based on an electrical current that is produced and transmitted within the heart. In some individuals this electrical circuit is becoming dysfunctional, either in the generator or in the wires. This may cause significant slowing of the heart rate (bradycardia) and cause symptoms such as dizziness, somnolence, fatigue and fainting. In these cases other causes of bradycardia need to be excluded (thyroid disease and medication).
If no cause is identified, then a pacemaker should be implanted. The implantation is a relatively safe procedure which is performed with a local anesthetic. The pacemaker is then programmed in way that will benefit the patient’s needs and activities.
Implantable cardioverter defibrillator is a specific form of pacemaker which is designed for detection and treatment of lethal arrhythmias (ventricular tachycardia and ventricular fibrillation) by delivering an electrical impulse to the heart. It is only implanted after a careful selection and detailed risk stratification.
Uric acid is a product of metabolized proteins and it can often be elevated. High levels of uric acid in the blood (hyperuricemia) may be attributed to nutritional habits, excessive use of alcohol, medication (diuretics) or even to a genetic predisposition. In cases of profound and prolonged hyperuricemia several complications may occur, such as uric arthritis and formation of kidney stones. It is possible with modification of nutrition, adequate intake of water and pharmaceutical intervention to restore normal values of uric acid. Lately it has been suggested that hyperuricemia is positively correlated with the risk of myocardial infarction.
This linkage may be explained by the nutritional habits of those individuals and also by a genetic substrate. Consequently, it is important that the uric acid levels are regularly monitored with blood analysis and when necessary to be effectively corrected. Individuals with high levels of uric acid are reasonable to be also tested for underlying cardiovascular disease.
Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.
Copyright by Dr Yiannis Panayiotides 2018. All rights reserved.