Specialist for Internal Medicine and Cardiology
Vienna University Department of Internal Medicine II (Cardiology), AKH-Vienna
1190 Wien, Heiligenstädter Straße 46-48
Tel: 0699/ 194 653 18
Phone:
0699 194 653 18
Fax:
02243 20 675
www.kardiologie-praxis.at
Frequent cardiological diseases
- Coronary artery disease
- Cardiac insufficiency
- Valvular defect
- Cardiac arrhythmia
Coronary artery disease
Coronary artery disease is a condition of the coronary heart vessels (coronary arteries). Its most common cause is arteriosclerosis, where the artery wall thickens due to plaque, causing hardening, as well as a decrease in the vessel’s cross section. The result is insufficient blood supply and thus insufficient oxygen supply for the heart muscle. This leads to disaccord between oxygen need and supply, which is called ischemia or coronary insufficiency.
The cardinal symptom of coronary artery disease is angina pectoris (chest tightness). As the disease progresses, the chances for attendant symptoms such as cardiac arrhythmia or cardiac insufficiency, as well as life threatening complications like heart attack or sudden cardiac death increase.
Coronary heart disease is a chronic condition, slowly progressive over years and decades. There is no cure for this condition; however, it is possible to fight aggravation by avoiding or pharmaceutically treating risk factors. Additionally, there are certain therapeutic interventions by means of catheter or surgery to treat coronary artery disease. With its acute manifestations, coronary artery disease is one of the main causes of death in developed nations.
Stable angina pectoris
In this case stable denotes that the angina pectoris always occurs under the same circumstances. There are four different stages, with each of which the pain and the constraint entailed with it, increase.
- Stage 1 – slight form, no medical conditions in daily life
- Stage 2 – daily activities are only slightly limited. Conditions only during hasty ascending of stairs, walking uphill, cold and headwind.
- Stage 3 – daily activities very limited, e.g. walking up one staircase
- Stage 4 – heavy form with conditions during rest
Unstable angina
In this case unstable refers to the fact that conditions might change or worsen. A distinction is made by:
- Rest angina – pain attacks usually last more than 20 minutes
- Progressive angina – angina pectoris where symptoms worsen within a period of 2 months by one grade
Typical angina pectoris
- Type of pain: Pressure in the chest region, tightness in the chest, burning session or choking
- Location of pain: Above the breastbone, upper central abdomen and throat, jaw, left should and arm, left blade bone
Atypical angina pectoris
There might also be atypical conditions, which might occur during certain positions. Pain might only occur at night or can vanish during physical exercise.
Heart attack
Heart attacks are today’s most common cardiovascular problems. The first signs of a heart attack are usually:
- Persistent pain in the chest
- Shortage of breath, nausea and vomiting
- Paleness, cold sweat
- Sudden circulatory collapse with or without loss of consciousness
The earlier a patient receives treatment, the higher the chances of survival. The first measure is the attempt to remove the obstruction or occlusion of the coronary blood vessel. Immediate treatment can prevent sustained damage.
Treatment options
Pharmaceutical treatment of risk factors
Dilatation (PTCA) and stentimplantation
PTCA means percutaneous transluminal coronary angioplasty and refers to the
possibility of widening a narrowed or obstructed coronary blood vessel by means
of intracardiac catheter (coronary angioplasty). In coronary angioplasty access
is gained through the ingenual artery and a contrasting medium is injected to
depict the coronary arteries. Should an obstruction or stenosed area become visible,
PTCA is the next step. Usually a stent (stainless steel support tube for the artery)
is implanted during this procedure to keep the vessel open. A stent is a small
tube made out of wire mesh and permanently remains in the blood vessel.
Aortocoronary bypass (ACBP)
Aortocoronary bypass (ACBP), also coronary artery bypass graft (CABG) surgery is the most frequently performed heart surgery in developed countries. It is the means of treatment for patients with more than one stenosed area and is applied to ensure long-term survival and improve quality of life. The procedure is indicated when stenosed areas have been located through coronary angiography and when these areas cannot be treated with other interventional measures. During the procedure arteries from healthy areas of the body (e.g. thoracic artery, crural vein, and antebrachial vein) are used to bridge obstructed or stenosed areas. The chest is opened, the patient connected to a heart-lung machine and the bridge is sewn on to the coronary arteries beyond the blockages and the other end is attached to the aorta using thin thread.
Cardiac insufficiency
Heart failure or cardiac insufficiency is a condition where the heart cannot guarantee the supply of the organs. Causes for cardiac insufficiency are:
- Myocardial infarction (heart attack)
- Long-term hypertension (high blood pressure)
- Inflammations of the heart muscle
- Alcohol dependency
- Accumulation diseases
Cardiac insufficiency is generally treated by medication or by means of cardiac pacemaker.
Valvular defects
Heart valves are structures of connective tissue between the atria and the ventricles of the heart (atrioventricular valves: tricuspid valve, mitral valve) and separate ventricle and larger vessels (semilunar valves: aortic valve and pulmonary valve). A distinction is made between congenital and acquired valvular defects.
Congenital defects are malformations at the time of birth; the condition of the valve in question usually worsens over the course of life. Acquired defects are caused by inflammations of the valves (endocarditis) or by increasing calcification.
Treatment options are either medication or two types of surgery
Reconstruction of the valve
The majority of the valve can be sustained, all superfluous parts are excluded, and in case of incomplete closure of the valve a synthetic ring is sewed to the valvular attachment. This procedure cannot be applied for completely destroyed valves or calcified valves.
Valvuar prosthesis
There are mechanical as well as biological valvular prosthesis. The mechanical ones are more durable, but require lifelong taking of certain medication (Marcoumar). Biological valves suffer from speedier calcification.
For all bearers of valvuar prosthesis it is obligatory to take endocarditis prophylaxis in form of antibiotics in case of any injury or surgical procedure. All patients with such prosthesis will receive a document informing about the valvular prosthesis, which they are required to carry with them at all times.
Cardiac arrhythmia
An irregular heartbeat is the most frequent form of cardiac arrhythmia (atrial fibrillation). This condition is treated with medication (antiarrhythmics and usually also coumarin). This type of cardiac arrhythmia is not life threatening, it can however have a limiting influence onto the physical performance. Occasionally, electrical conversion therapy (electroshock) is suggested.
For your information, normal pulse should range between 50 and 100 beats per minute and show certain regularity. A heart rate under 40 beats per minute (bardycardia) most frequently requires treatment with a pacemaker, while ventricular arrhythmia, when the heart rate exceeds average (ventricular tachycardia) requires a special type of pacemaker combined with a defibrillator (AICD).
Pacemakers
Pacemakers are implanted should the electrical system of the heart no longer be adequate. Reasons for this can be found on different ‘levels’ of the heart (sinus node, AV node, bundle of HIS etc). Procedures are usually performed under local anaesthesia. Thanks to modern technique, pacemakers only weigh 20g and are implanted below the collarbone. The electrodes run ‘invisibly’ inside the veins into the heart.
Depending on the disturbance, the heart needs impulses in the right ventricle (single chamber pacemaker) or in the atrium as well as the ventricle (dual-chamber pacemaker). Batteries are exchanged after 8 to 10 years. In case of severe cardiac insufficiency, a three chamber system might be needed, where a third electrode is implanted into the left ventricle.
AICD
An automated implantable cardio converter-defibrillator (AICD) limits fast life-threatening ventricular arrhythmia (originating from the ventricles) by an electrical impulse. At the same time heavy medication for stabilizing the heart rhythm will have to be taken on a continuous basis.
Every patient with a pacemaker will receive a document informing about the existence of the pacemaker, which has to be carried at all times. Daily life is not influenced by the pacemaker; however heavy magnetic fields should be avoided (MRIs, security lock at the airport etc). Usage of mobile phones or cordless phones is possible.