The cardiovascular diseases encompass a multitude of diseases related to poor functioning of the heart or blood vessels that feed it.
This sheet focuses on the 2 most common disorders:
The angina occurs when there is a lack of oxygenated blood to the heart muscle. It causes a seizure of sharp pains in the heart, felt in the area of the chest. This disorder occurs during the effort and disappears in a few minutes with rest or taking nitroglycerin, without leaving a sequela. The term “angina” comes from the Latin angere , which means “to strangle”;
The myocardial infarction or heart attack means a more violent crisis as angina. The lack of oxygen causes necrosis , that is to say the destruction of part of the heart muscle, which will be replaced by a scar . The ability of the heart to contract normally and pump a normal amount of blood at each beat may be affected; it all depends on the extent of the scar. The term “infarction” comes from the Latin infarcire, which means stuffing or filling, because the heart tissues seem so full of liquid.
The heart is a pump that allows blood to be distributed to all organs, and thus ensures their functioning. But this muscle also needs to be fed with oxygen and nutrients. The arteries that supply and nourish the heart are called coronary arteries (see diagram). Angina attack or myocardial infarction occurs when the coronary arteries are obstructed, in part or completely. Heart regions that are no longer well irrigated contract poorly or stop doing so. This type of situation occurs when the walls of the arteries of the heart have been damaged (see Atherosclerosis and Arteriosclerosis below).
The age at which a first angina attack or infarction is declared depends in part on heredity , but essentially on lifestyle habits : diet, physical activity, smoking, alcohol consumption and stress.
According to the Heart and Stroke Foundation, approximately 70,000 people in Canada suffer a heart attack each year. Nearly 16,000 of them succumb to it. The vast majority of those who survive recover enough to return to an active life. However, if the heart is severely affected, it loses a lot of strength and hardly meets the needs of the body. Simple activities, such as dressing, become breathless. It’s heart failure.
Atherosclerosis and Arteriosclerosis
The Atherosclerosis refers to the presence of a plaque on the inner lining of the arteries that obstructs or blocks the flow of blood. It forms very slowly, often many years before a bout of angina or other
Symptoms occur. Atherosclerosis mainly affects large and medium-sized arteries (for example, coronary arteries, arteries of the brain and arteries of the limbs).
It is often associated with arteriosclerosis: that is, hardening, thickening and loss of elasticity of the arteries.
Cardiac disorders (cardiovascular diseases)
How does myocardial infarction occur?
The majority of myocardial infarctions occur in 3 successive stages.
First, the inner wall of the artery must suffer micro – injuries. Various factors can damage arteries over time, such as high levels of blood lipids, diabetes, smoking and high blood pressure.
Most of the time, the story stops here, because the body treats these microblessures well. On the other hand, it happens that the wall of the artery thickens and forms a kind of scar called “plaque “. It contains cholesterol deposits, immune cells (because micro-injuries triggered an inflammation reaction) and other substances, including calcium.
Most plates are not “risky”; they do not get fat or do it very slowly, then stabilize. Some can even reduce the opening of coronary arteries by as much as 50% to 70%, without causing symptoms and without getting worse. For an infarct to occur, a blood clot must form on a plaque (which was not necessarily large). In a matter of hours or days, the artery can be completely clogged with clot. This is what creates infarction and sudden pain, without any form of warning.
The steps that lead to the formation of a blood clot on a plate are not completely elucidated. The clot is made of coagulated blood. As when there is an injury to a finger, the body wants to repair it by coagulation.
The Atherosclerosis tends to affect more arteries in both. It also increases the risk of other important health problems, such as a stroke or kidney failure.
Symptoms of cardiovascular disorders
The symptoms can be intense and abrupt, but most of the time the discomforts are mild at first and then increase. If you experience any of the following symptoms, contact the emergency services.
For myocardial infarction:
Its manifestations resemble those of angina pectoris, but are more pronounced and persist longer (often more than 20 minutes). In the elderly and those with diabetes, infarction sometimes goes unnoticed.
People at risk
From a certain age, it is normal for the risk of cardiovascular disorders to increase. In men, it is considered that the risk begins to increase from 40 years, and in women, after menopause.
People who have had a family member who has suffered early enough from cardiovascular problems (father or brother before age 55, mother or sister before age 65) are at higher risk.
The lifestyle habits are closely linked to the health of the heart and blood vessels. According to the World Health Organization, the bad food, the lack of physical activity and smoking are responsible for about 80% of heart disease and stroke.
The Inter heart 3 study, conducted in 2004, remains an important reference for health professionals. The data come from 52 countries on 5 continents, for about 30,000 participants. His results indicate that 9 factors (6 risk factors and 3 protective factors) predict 90% of myocardial infarction in men and 94% in women. This study highlighted the significant impact of chronic stress on heart health.
The 6 risk factors:
- Hypercholesterolemia: risk 4 times higher;
- Smoking: risk 3 times higher;
- Diabetes: risk 3 times higher;
- Hypertension: risk 2.5 times higher;
- The chronic stress (depression, job stress, relationship problems, financial problems, etc.): risk 2.5 times higher;
- A high waist circumference (abdominal obesity): risk 2.2 times higher.
The 3 factors that exert a protective effect:
- Daily consumption of fruits and vegetables ;
- Moderate consumption of alcohol (the equivalent of 1 consumption per day for women and 2 for men);
- Regular exercise.
- Note that the relative importance of each of these risk factors varies from one individual to another, and also from one country to another.
The following medications are used to treat or prevent angina attacks and to prevent recurrence of myocardial infarction.
- Lipid- lowering drugs to lower cholesterol levels: statins, bile acid chelators, etc.
- Antinational, to treat coronary insufficiency: beta-blockers, calcium channel blockers, nitrates.
- Antiplatelet agents: acetylsalicylic acid (aspirin) and clopidogrel.
- Researchers are working to create molecules that can raise the level of good cholesterol (HDL).
Depending on the case, any of the following may be indicated to prevent recurrence of myocardial infarction.
Percutaneous coronary intervention. This intervention, performed by an interventional cardiologist, involves first inserting a catheter with an inflatable balloon to open a blocked artery, called angioplasty. The insertion of the catheter is practiced in an artery of the wrist or groin.
At the time of surgery, a small metal stent, or stent, is frequently introduced into the artery, reducing by half the risk of the artery becoming blocked again. To increase their effectiveness, some tutors are covered with a drug (for example, sirolimus or paclitaxel).
Bypass surgery. The surgeon grafts a blood vessel from a leg or chest to create a new blood passage to bypass a blockage in a coronary artery. Physicians opt for bypass surgery when multiple coronary arteries are blocked or narrowed, or when the main coronary artery is affected. This procedure usually occurs in case of diabetes or heart failure, or if several blood vessels is obstructed.
Important. Percutaneous coronary intervention and coronary artery bypass surgery are not miracle solutions that solve all the problems. Many people wrongly believe that such interventions are enough to put them out of danger and allow them to resume their old ways of life.
Modification of the habits of life
Physicians are increasingly emphasizing the need to change lifestyle habits to slow or stop the progression of the disease, as explained in the Prevention section:
- No smoking;
- To exercise;
- Eat well;
- Maintain a healthy weight
- Have a good sleep;
- To learn to relax;
- To express emotions, etc.
Infarction affects the heart, but also the brain and sleep?
Insomnia problems are common during the 2 weeks following a heart attack. Experts have long thought that stress was the cause. Infarction may not only affect the heart, but also neurons in the brain that play a role in sleep. This is at least a hypothesis supported by Quebec researchers 48.
The treatment centers in cardiology now offer nutrition counseling, physical exercise programs, support programs for smoking cessation, relaxation workshops, stress management, meditation, etc.
- These measures have both preventive and curative value.
- Learn from the Mediterranean diet
- Many cardiologists recommend this diet, which is effective in preventing recurrence.
Studies have shown that the Mediterranean diet can reduce the risk of recurrence of coronary heart disease by 70% compared to a balanced diet 34-36.
The Mediterranean diet is characterized by an abundance of vegetables and fresh fruit, the use of olive oil as a source of fat, the consumption of fish and also wine, in moderate quantities.
Psychotherapy as part of the treatment of cardiovascular disorders – or even better, in prevention – can bring many benefits 39, 55. Chronic stress, anxiety, social isolation and aggression are all factors that, unknowingly, affect our nervous system and undermine our cardiovascular health. In addition, to overcome these problems, it is common practice to use behaviors that, instead of helping us, aggravate the problem: smoking, alcoholism, compulsive eating, etc.
In addition, people who, after a bout of angina, for example, are encouraged to rethink their lifestyle (exercise, quit, etc.), have an interest in taking all possible means to get there. In all cases, psychotherapy can play a leading role.