Overview of cardiovascular diseases
Cardiovascular diseases are the most common cause of death in Switzerland. But the earlier they are diagnosed, the better the chance of survival. Professor Frank Ruschitzka from Zurich University Hospital provides an overview of the most common diseases.
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With over 20,000 deaths per year, cardiovascular diseases remain the most common cause of death in Switzerland. The good news is that the earlier a diagnosis is made and targeted heart attack treatment is initiated, the higher the chances of survival for those affected. It is particularly important to treat risk factors in good time, because prevention is the best defence.
A healthy lifestyle, regular exercise, a balanced diet and no smoking can significantly reduce the risk of cardiovascular disease and prevent heart attacks. In addition, early treatment of high blood pressure, diabetes or high cholesterol levels can play a crucial role in further reducing the risk and protecting the heart.
Coronary heart disease
The coronary arteries are essential for supplying the heart muscle with oxygen-rich blood. They branch out from the main artery (aorta) and run over the surface of the heart to supply all parts of the heart muscle evenly with oxygen and nutrients.
Sufficient blood flow through the coronary arteries is crucial to ensure the heart’s continuous pumping capacity and to maintain the oxygen supply to the entire body.
If these arteries narrow, this is known as coronary heart disease. In the worst case, a complete vascular occlusion develops, which can lead to a heart attack. Coronary heart disease is one of the most common cardiovascular diseases. Men over the age of 45 and women over the age of 55 are particularly at risk.
Angina pectoris
Angina pectoris literally means a feeling of tightness in the chest. It is a symptom of coronary heart disease and can be a harbinger of a heart attack.
Heart attack
Heart attacks often occur without warning. They often cause sudden pain or discomfort in the chest that does not go away – the pain can feel like squeezing or pressure inside your chest and can spread to the arm or neck.
However, women, diabetics or older patients in particular often experience atypical symptoms, such as nausea, tiredness or abdominal pain. As a result, the symptoms often go unnoticed and it is much harder to make a quick diagnosis.
Silent heart attacks have few or no symptoms, or symptoms that you might not associate with a heart attack.
The following symptoms are indications of a heart attack:
- Severe pain, pressure, tightness or burning in the chest
- Pain radiating to the arms, neck, jaw or upper abdomen
- Shortness of breath and fear of death
- Cold sweat and weakness
- Nausea and vomiting
Even if symptoms may be unspecific and unclear, emergency diagnosis and treatment of heart attack patients is important. Do not hesitate to call the emergency services or go to A&E if symptoms come on suddenly. The medical team will make a diagnosis and decide whether treatment is necessary. Once the diagnosis has been made, treatment is started in hospital with a cardiac catheter. The aim is to reopen the blocked coronary artery as quickly as possible, restore the function of the heart and prevent permanent damage.
Heart attacks: symptoms in women
The symptoms of a heart attack in women can be more subtle and less obvious than in men, which can lead to a delayed diagnosis. Women often experience atypical symptoms such as nausea, vomiting, back pain, a sore jaw or throat, and severe fatigue.
Chest pain or pressure can also occur, but is often less intense than in men. Shortness of breath, dizziness or a general feeling of discomfort and anxiety can also be signs of a heart attack in women.
As these symptoms are not always an obvious indication of a heart attack, it is important that women take these unspecific signs seriously and seek medical help in good time.
Due to the significant differences between women and men in terms of disease progression, diagnosis and treatment, a Women’s Heart clinic has been set up at the Department of Cardiology at Zurich University Hospital.
Cardiac insufficiency/heart failure
Heart failure can be caused by a wide range of heart diseases. With increasing heart failure, the heart muscle can become so weakened that it can no longer pump enough blood through the body to meet the needs of the organs.
As a result, the organs, muscles and tissues are no longer supplied with sufficient oxygen and nutrients. Water also collects in the legs, abdominal cavity and the lungs. The most common symptoms include shortness of breath, swollen legs, increased fatigue and poor performance. However, various other symptoms such as palpitations, nausea, loss of appetite and digestive problems can also occur.
Heart valve defect
Healthy heart valves are important so that the heart can do its job and pump blood through the circulatory system. The heart valves ensure that the blood is pumped in the right direction and that the heart can work effectively.
Each valve consists of thin flaps of tissue (leaflets or cusps) that open and close to regulate blood flow. Heart valves can become leaky (insufficiency) or too narrow (stenosis) due to age, inflammation, genetic predisposition or high blood pressure.
If a heart valve is leaking or narrowed, those affected may not notice it at first, but over time they will experience symptoms. Patients sometimes suffer from cardiac insufficiency, which can cause shortness of breath, reduced performance and an urge to cough, for example. In advanced stages, cardiac arrhythmias can also develop. In the event of an acute bacterial infection in the body, germs can also adhere to the surface of the valve and cause dangerous changes.
Cardiac arrhythmia
Cardiac arrhythmia is when the heat beats faster than 100 times per minute or slower than 60 times per minute, if it beats irregularly or if there are pauses that last longer than three seconds. Symptoms can include heart palpitations, cardiac irregularity, a slow heartbeat, dizziness or fainting.
Pronounced cardiac arrhythmias are often caused by a disease. A cardiologist will perform a thorough examination to decide whether a cardiac arrhythmia is dangerous and requires treatment. Any new symptoms such as dizziness, reduced performance or chest pain should be investigated.
Treating cardiac arrhythmia
Treatment is necessary if the heart function, and therefore the patient’s quality of life, is impaired by the arrhythmia. Cardiac arrhythmia is particularly dangerous if it occurs alongside a heart disease, such as a heart attack or cardiac insufficiency.
Some cardiac arrhythmias can be remedied relatively easily, especially if they are caused by lack of sleep, stress, a mineral imbalance or excessive consumption of coffee and alcohol. Medication can help to suppress arrhythmias and is mainly used to prevent and treat acute or chronic cardiac arrhythmias.
If medication does not help in the long term, modern, minimally invasive catheter procedures can be used to sclerotise the specific area of the heart that is causing the disorder. With a number of cardiac arrhythmias, this can help restore the heart’s normal rhythm. The earlier the treatment, the better the chances of recovery.
Consequences of inflammation of the heart?
Inflammation of the heart differs according to which area of the heart is affected. Endocarditis affects the inner lining of the heart, myocarditis the heart muscle, and pericarditis the outer layer of tissue that surrounds the heart like a sac. Inflammatory processes in the blood vessels also contribute to the development of atherosclerosis. Atherosclerosis, sometimes called “hardening of the arteries,” occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. This causes the blood vessels to constrict and thus prevent the adequate flow of blood through them.
Pericarditis (inflammation of the pericardium)
The pericardium consists of two layers, the space between which is filled with fluid. This fluid allows the two layers of the pericardium to glide over each other and the heart can expand and contract with ease.
If these layers become inflamed due to pericarditis, the resulting secretion flows into the space between them and can impair the functioning of the heart. Pericarditis is very often caused by viruses, sometimes also by bacteria. It is frequently a concomitant symptom of other illnesses.
Endocarditis (inflammation of the inner lining of the heart)
Endocarditis is an inflammation of the inner layer of the heart (endocardium), which also includes the heart valves. It is usually caused by a bacterial infection, although less commonly it can be the result of a fungal infection. The infection gets into the bloodstream and the bacteria attach to the endocardium. The bacteria can enter the bloodstream as a result of skin injuries, dental infections, operations or other procedures.
The disease damages the heart valves by destroying tissue and forming deposits (vegetations), which can lead to serious complications such as heart valve damage and heart failure or cause the infection to spread to other organs.
People with damaged or artificial heart valves or certain heart defects have a higher risk. Treatment usually involves antibiotics and, in severe cases, surgery may be required to remove or replace the infected valve.
Myocarditis (inflammation of the heart muscle)
Myocarditis is an inflammation of the heart muscle. Doctors distinguish between acute and chronic myocarditis. With a chronic condition, the heart muscle can dilate irreparably over time (dilated cardiomyopathy), causing it to lose its pumping power. Those affected then suffer from heart failure and usually have to take medication for the rest of their lives.
Cardiovascular diseases: causes and risk factors
Certain risks for cardiovascular diseases cannot be influenced. These include age, sex, congenital heart defects and hereditary predisposition. If there is a family history of cardiovascular diseases, it is all the more important to maintain a healthy lifestyle. Many of the causes of acquired heart disease are associated with an unhealthy lifestyle.
These include the following risk factors:
High blood pressure – the most common risk factor
High blood pressure is a key risk factor for cardiovascular disease. As you get older, you should have your blood pressure, cholesterol and blood sugar levels checked regularly. Timely treatment helps prevent heart disease and reduces the risk of a stroke.
It is estimated that one in four adults in Switzerland have high blood pressure. High blood pressure develops silently. As it usually doesn’t cause pain, it often goes unnoticed for a long time. This means that one in three people usually don’t know that their blood pressure is too high. It can take years or even decades before initial symptoms occur.
And the problem is that long-term high blood pressure can damage the heart, blood vessels, brain, eyes and kidneys and increase the risk of a heart attack, stroke or kidney disease. So it’s all the more important to have your values checked regularly and pay attention to warning signs.
Possible symptoms of high blood pressure include:
- Headaches
- Dizziness
- Nosebleeds
- Ringing in the ears
Signs that organ damage has already occurred can include:
- Shortness of breath
- Breathlessness
- Pain and pressure in the chest (angina pectoris)
- Visual or sensory disturbances
- Heart attack
- Stroke
Good to know
A hypertensive emergency is indicated by stroke-like symptoms, such as dizziness, visual disturbances, paralyses or temporary loss of consciousness.
In this case, the blood pressure values have to be reduced quickly otherwise they can damage organs such as the brain, eyes or heart. Call the medical emergency service (144) immediately.
About the expert
Professor Frank Ruschitzka is Director of the Cardiology Department at Zurich University Hospital.