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Cardiovascular Diseases: prevent to protect the heart

Cardiovascular diseases encompass all pathologies involving the heart and blood vessels.

The heart is the most important organ in our body, but we often fail to take care of it properly. Apart from congenital heart diseases, which fortunately are not very common, if we do not follow a correct lifestyle (regular physical activity, not smoking, moderate alcohol consumption, balanced diet), especially if we suffer from conditions such as high blood pressure, diabetes mellitus, obesity, hypercholesterolemia, the risk of being affected by the most severe clinical manifestations of cardiovascular diseases (myocardial infarction, sudden death, stroke) increases as we age.

Essentially, the heart is a muscular pump that aspirates/pumps blood through rhythmic contractions, circulating blood sequentially in the two circuits constituted by the systemic circulation and the pulmonary circulation. Inside, it consists of four chambers, two atria and two ventricles, and four valves: the right sections of the heart (right atrium and ventricle) collect blood from the superior and inferior vena cavae, pump it through the pulmonary artery into the pulmonary circulation, where it will be enriched with oxygen and lose carbon dioxide, returning through the pulmonary veins to the left sections in the left atrium, and from there, pass into the left ventricle, from where, exiting through the main arterial trunk of the body, the aorta, it will again take the path of the systemic circulation, distributing oxygen and nutrients to all the cells that make up our body.

Atria and ventricles are separated by one-way valve systems (the tricuspid in the right ventricle, and the mitral in the left ventricle) to direct blood flow correctly, while at the exit of the right and left ventricles, respectively, the pulmonary valve and the aortic valve act with the same mechanism for the same purpose. The heart’s nourishment is ensured by a special arterial circulation that originates from the first part of the aorta: the coronary arteries.

Cardiovascular Diseases: What They Are and How to Recognize Them

The main cardiovascular disease conditions include:

Heart: angina pectoris, myocardial infarction, sudden cardiac death; Brain: transient ischemic attacks (TIAs, RINDs), stroke, cerebral hemorrhage; Peripheral arterial circulation: claudication, peripheral arterial disease.

The common denominator that unites them is a degenerative process of the inner surface of the arteries, called atherosclerosis: the inner wall of the arterial vessels, from birth to adolescence, is smooth and regular.

Over the subsequent years, due to the negative combined action of various conditions (known as risk factors, many of which are reversible or modifiable with appropriate therapies) such as high blood pressure, diabetes mellitus, sedentary lifestyle, overweight, hypercholesterolemia, lipid profile disorders, tobacco smoking, stress, male sex, and age, “plaques” form on the surface of the arterial vessels. Growing progressively, they can completely obstruct the vessel itself, leading to the actual death of the tissues downstream of the obstruction because they no longer receive the necessary blood supply for their survival: this mechanism results in what is commonly known as a heart attack.

If the obstruction is partial, situations of oxygen supply deficiency to tissues arise, known as angina pectoris. Sometimes, in the heart, it’s the smallest vessels, the capillaries, which are not visible to the naked eye but only under a microscope, that are affected by general conditions (stress, viral infections, inflammatory states) and result in reduced oxygen supply to tissues. In general, the term ischemia encompasses all conditions of reduced blood (and therefore oxygen) supply to tissues, even without obstruction of the coronary arteries.

In Italy, cardiovascular diseases still represent the leading cause of death, with a total number of 240,000 deaths in the year 2020: the majority of deaths are progressively concentrated in the decades of life over 40 years to reach a peak between 80 and 90 years.

Yet, there would be a vast space for prevention, which is not used as it could be: completely abolishing tobacco smoking, engaging in regular physical activity, early diagnosis and appropriate treatment of high blood pressure and diabetes mellitus, reducing body weight to within normal limits, limiting the use of animal fats and red meats in the diet, avoiding stress are all behavioral strategies that delay the onset of atherosclerosis and its consequences.

It is very important to recognize the symptoms of cardiovascular diseases so that one can suspect their presence, and consequently provide the necessary assistance:

Myocardial infarction typically presents with pain lasting many hours in the anterior chest wall or pain localized to the epigastric region: the most common sensation is that of pressure on the chest, a gripping sensation; often associated with cold sweats, extreme fatigue, and radiating pain to the left arm down to the hand, towards the neck and jaw), towards the back of the chest in the area between the shoulder blades. Angina pectoris has the same presentation as a heart attack: the symptoms are the same, although more subtle, and may occur during physical activity or exertion. The duration is characteristically limited: anginal pain usually lasts no more than 30 minutes and resolves on its own with rest; if it persists beyond 30 minutes, then we are facing a heart attack scenario.

In both cases, or in doubt, it is necessary to call the emergency service of the Territorial Medical Emergency Service 118 because the most dreaded complication of the early stages of a heart attack is malignant ventricular arrhythmias that can cause sudden death from ventricular fibrillation.

Intermittent claudication presents with pain occurring in the calf and/or thigh during physical activity such as walking: the pain disappears upon stopping and resumes when walking resumes; it is related to obstruction of arterial vessels by atheromatous plaques. Stroke usually presents with the sudden onset of motor deficits that may involve the facial muscles, shoulder, arm, hand, or other neurological symptoms such as the inability to speak: it can be caused by atherosclerotic obstruction of vessels carrying blood to the brain, or by hemorrhagic phenomena due to rupture of the walls of smaller arterial vessels that supply the brain, always due to atheromatous lesions of the vessel wall.

Prevention of Cardiovascular Diseases

Heart diseases can be prevented: primary prevention is the treatment of those conditions known as risk factors that, when present, increase the chance of developing a cardiovascular disease. Risk factors can be distinguished into two large subgroups:

Modifiable: high blood pressure, diabetes mellitus, obesity, tobacco smoking, sedentary lifestyle, hypercholesterolemia; with the pharmacological therapies available today and with appropriate modifications to diet and lifestyles, the onset of clinical manifestations of heart diseases can be significantly delayed over time; Non-modifiable: age, sex, family history;

Tables are available that measure the risk of experiencing cardiovascular events (heart attack, stroke, sudden death) in the next ten years, based on risk factors and their degree of control at the time of assessment: this is the Cuore project of the Higher Institute of Health, which can be easily consulted online.

A cardiological visit is always a good choice to assess one’s cardiovascular condition and evaluate the risk profile, with the aim of effectively preventing cardiovascular diseases and their sometimes dramatic consequences.

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