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Treatment of Cardiovascular Diseases

If significant narrowing and/or occlusion of the coronary arteries is detected, balloon angioplasty can be performed in the same session or later if necessary. Balloon angioplasty involves inflating a specially made balloon for a short period of time and widening the narrowing of the vessel. The balloon can be used for more than one stenosis in the same vein or for stenoses in more than one vein in the same session or in different sessions. If necessary, a stent is placed in the area using a balloon in addition to it.

In the balloon procedure, a catheter with an inflatable balloon at its tip is inserted into the area of stenosis (A). After it is placed in the narrowed area, the balloon is inflated and the stenosis is opened (B).

In cases not suitable for balloon angioplasty, bypass surgery or medication therapy may be recommended.

In bypass surgery, a vessel that serves as a bridge is inserted between the front and back of the site where the stenosis begins. This vessel can be the patient’s own saphenous vein or an artery (lima) from the chest. This allows blood to flow beyond the narrowed or occluded area with the help of this bridge.

Here we see LIMA bypass to the left anterior descending artery (LAD) and saphenous vein bypass to the right coronary artery (RCA).

Medications used for coronary artery disease dilate the coronary arteries, reduce the load on the heart, prevent the formation of blood clots in this area, or lower cholesterol levels, which have a very negative effect on atherosclerosis. The medicines should be taken continuously and under the supervision of a doctor.

Here we see that the leg vein (saphenous vein graft) is anastomosed to the left anterior descending artery (LAD). First, one end of the graft is sutured to the LAD, then the other end is sutured to the aorta. Thus, blood coming from the aorta bypasses the occluded area on the other side of the artery and supplies the heart.

Unfortunately, neither the medications used in the treatment of coronary artery disease nor the balloon and bypass can eliminate the vascular disease. Therefore, new stenoses may occur in the same region or in different regions of the coronary vessel, or a mild stenosis may progress and become a severe stenosis and cause problems. For this reason, it is very important for patients to take their medications regularly and to come in for checkups at times recommended by their doctor to eliminate risk factors and whenever they have other symptoms to detect problems early.

Symptoms in Cardiovascular Diseases

We can summarize the findings or clinical findings in cardiovascular diseases as follows:

* Chest pain (angina pectoris)
* Myocardial infarction (heart attack)
* Rhythm disturbances (arrhythmia)
* Heart failure
* Sudden death
* Sometimes no symptoms occur, although cardiovascular disease significantly impairs the supply of the heart (silent ischemia).

Chest pain occurs when the coronary arteries narrow significantly (angina). It is a compressive, squeezing pain that is usually accompanied by fatigue, emotional stress, or coldness, may spread to the anterior chest, left arm, neck, and jaw, lasts 10-15 minutes, and is relieved by rest or taking medications that widen the coronary arteries (stable angina). However, in some cases, dynamic changes may occur at the site of the stenosis. In these cases, the pain may occur even at rest, last longer, and not respond readily to rest or medication (unstable angina). This type of angina is more dangerous because it can easily lead to a heart attack (infarction).

Parts of the body where heart-related chest pain (angina pectoris) is felt.

When the narrowing of the vessel progresses and leads to vascular occlusion, the cells of the part of the heart supplied by that artery no longer function. If the atherosclerosis of the artery lasts longer than 6 hours, the cells of this part cannot maintain their vitality and are irreversibly destroyed. As a result, this part of the heart can no longer contract, cardiac arrhythmias can occur along with serious problems that can lead to death. We call this a heart attack (myocardial infarction).

In infarction, chest pain is similar in location and extent to angina, but much more severe and prolonged. Diagnosis of a myocardial infarction involves not only symptoms but also an electrocardiogram (ECG) and blood tests. If vascular occlusion is opened with balloon or thrombolytic therapy in the first 6 hours after a myocardial infarction, damage to the myocardium may be prevented, so early diagnosis is very important. It should be remembered that 50% of deaths from myocardial infarction occur within 1 hour. The vast majority of these deaths are due to cardiac arrhythmias, which can be easily treated in hospitals. Therefore, patients with similar pain should see a doctor as soon as possible, especially if they are known to have cardiac disease.

However, the usual rules in medicine do not always apply. Sometimes angina or pain due to myocardial infarction does not occur at all, especially in the elderly and diabetics. Such patients may have a silent infarction. Again, instead of chest pain, some patients may have complaints of indigestion, abdominal pain, dyspnea, back pain, arm pain, jaw pain, and even tooth pain.

Risk Factors in Cardiovascular Diseases

The most important step in the fight against coronary heart disease is the prevention of the disease. In the presence of a number of risk factors, the disease appears and progresses rapidly. A fine level of good cholesterol (more than 60 mg/dl) reduces the risk of disease.

What are the Risk Factors?

1- Age: Men over 45 years old, women over 55 years old or women with premature menopause

2- Gender: It is more frequent in men

3- Family history: Having a father or brother before age 55 or a mother or sister before age 65 who has been diagnosed with cardiovascular disease myocardial infarction or who has had a sudden death

4- Smoking

5- Having hypertension (140/90 mmHg or more or being treated for hypertension)

6- Having good cholesterol (HDL cholesterol) less than 40 mg/dl

7- Having a total cholesterol greater than 200 mg/dl (bad-LDL cholesterol greater than 130 mg/dl).

8- Inactivity: You should exercise for at least 30 minutes 3 days a week (brisk walking, swimming, cycling, dancing, gardening, etc.).

9- Diabetes Mellitus

10- Weight: The most important criteria in this context are body mass index and waist circumference. The formula for the body mass index is BMI = kg/m2, where kg stands for a person’s weight in kilograms and m2 stands for their height in meters squared. A body mass index of over 25 or a waist circumference of over 102 cm for men and 88 cm for women not only increases the risk of cardiovascular disease, but also the risk of diabetes, obesity and high blood pressure.

11- Stress: Exposure to constant stress over a long period of time favors the development of the disease.

12- Depression: Especially in the recent years, depression has been accepted as a risk factor in cardiovascular diseases.

What to do?

Some of these risk factors can be changed whereas some cannot (such as age, gender, family history).
Cardiovascular diseases are not transient diseases that leave no trace when they are cured unlike colds and flu. When the disease develops, it tends to progress continuously and cause problems. Therefore, it is extremely important to fight these risk factors, as this will prevent the disease from occurring and slow or even stop its progression in those who develop it. Thus, fighting cardiovascular disease means fighting changeable risk factors.

What is Cardiovascular Disease?

Facts

Being responsible for pumping the blood that carries the substances necessary for our organs to function, the heart contracts 70 times per minute to perform this task, sending an average of 70 ml of blood to our organs each time. During an average human lifetime, our heart contracts about 2.5 billion times, pumping 180 million liters of blood through our body.

Organs need nutrients and oxygen to maintain their vitality and perform their functions. These are transported to our organs through the blood. The blood is transported to the organs through the arteries. Our heart has the task of pumping the blood into the arteries. Like every organ, the heart needs nutrients. The arteries that supply the heart itself are called “coronary arteries”. Diseases that can occur in the coronary arteries are of vital importance, as they directly affect the work and efficiency of the heart.

Atherosclerosis

The most common and important disease of the coronary arteries is atherosclerosis. In this disease, a number of substances, mainly cholesterol, builds up in the coronary arteries, and stenosis and occlusion occur at these sites.

Here we see the development of atherosclerosis in the cardiovascular sections. The structures we call plaque, which form in the arteries as a result of atherosclerosis, can grow over time and narrow the vascular space. As the narrowing of the vessel reduces the amount of blood flowing through it, problems arise from malnutrition of the heart.

The resulting picture is called coronary artery disease or coronary heart disease. As a result, the supply of the heart is disturbed, and the rhythmic function and contraction of the heart is impaired according to the severity of the disease. Coronary artery disease is the leading cause of death and loss of working capacity in adults in our country and around the world.