Ins and Outs of CVDs (Cardiovascular Diseases)

Cardiovascular disease is the name given to disorders of the heart and blood vessels. The WHO stated that 32% of all global deaths in 2022 were caused by CVDs, and 38% of premature deaths (deaths under the age of 70) were also caused by CVD. Therefore, it is important to have an understanding of these diseases and their symptoms so that doctors can detect them early in patients and begin management with counselling and medication, increasing the chances of preventing future pain or complications.

The most common CVDs are:

• Coronary heart disease

• Stroke

• Hypertensive heart disease

• Rheumatic heart disease

Coronary heart disease / coronary artery disease / ischaemic heart disease

The heart’s blood supply becomes blocked or interrupted by a build-up of fatty substances over time in the coronary arteries, which supply blood to the heart muscle. This makes it difficult for the body to perform important functions and is more prevalent in people over the age of 40.

As a result of this blockage, arteries become narrowed and clogged with fatty deposits in a process called atherosclerosis. This can be caused by an unhealthy lifestyle, such as smoking and excessive alcohol consumption. Risk is also increased by conditions such as high cholesterol, hypertension (high blood pressure), and diabetes.

Patients may experience symptoms such as chest pain, shortness of breath, pain in the neck, jaw, arm or shoulder, feeling faint, or nausea; however, not all individuals with this disease will show symptoms.

If a doctor suspects CHD, they may perform tests such as an ECG, echocardiogram (an ultrasound that creates images of the heart), chest X-ray, or a coronary angiogram (a specialised X-ray used to visualise the heart’s blood vessels and detect blockages).

Treatment for CHD and prevention of heart attacks can include lifestyle changes in less severe cases, medication, procedures such as balloon angioplasty and stent placement to widen narrowed arteries, or, in more severe cases, surgery.

Stroke

A stroke is a sudden interruption of blood flow to the brain, leading to brain damage and other serious complications. There are three main types of stroke: ischaemic stroke, transient ischaemic attack (TIA), and haemorrhagic stroke.

Ischaemic stroke is caused by a blockage in a blood vessel and is the most common type, accounting for around 85% of all strokes in the UK. It is often caused by atherosclerosis, where fatty deposits build up inside artery walls. These deposits can inflame or rupture, leading to clot formation and blockage of blood vessels. If a clot travels to the brain, it can cause a stroke.

Risk factors include high blood pressure, high cholesterol, diabetes, smoking, and obesity. Another cause is small vessel disease, which involves damage to the tiny blood vessels deep in the brain, reducing blood flow and increasing the risk of bleeding. This can be identified on brain scans and may also lead to memory problems and dementia.

Other heart-related conditions, such as heart failure, arterial damage, heart infections, and patent foramen ovale (PFO), can also increase stroke risk. Treatment may involve breaking up or removing clots, blood-thinning medication, or surgery.

Haemorrhagic stroke accounts for about 15% of strokes in the UK and is caused by bleeding in or around the brain.

• Intracerebral haemorrhage (ICH): occurs when blood leaks into brain tissue. Causes include small vessel disease or abnormal blood vessels.

• Subarachnoid haemorrhage (SAH): occurs when blood leaks into the space surrounding the brain. It is the least common type and is often caused by a ruptured aneurysm (a weakened, bulging blood vessel).

Another associated condition is autosomal dominant polycystic kidney disease (ADPKD), which increases the risk of brain aneurysms. High blood pressure and smoking also increase the risk.

Treatment may involve surgery to stop bleeding and repair damaged blood vessels. Lifestyle changes such as quitting smoking and maintaining a healthy weight can help reduce risk.

Transient ischaemic attack (TIA), or “mini-stroke,” involves stroke-like symptoms that last for a short period of time. It is often caused by a temporary clot blocking blood flow to the brain. When the clot moves away, symptoms resolve.

A TIA is a warning sign that a person is at risk of a full stroke. Doctors may conduct tests to check for underlying conditions such as high cholesterol, high blood pressure, and diabetes. They may also monitor heart function or perform ultrasound scans of the neck arteries.

Because TIAs do not always cause permanent damage, they may not appear on scans; however, MRI scans may still be used to rule out other causes. Prevention strategies include blood-thinning medication, surgery to clear blocked arteries, or treatment of damaged arteries.

Hypertensive heart disease

Hypertension refers to high blood pressure, and hypertensive heart disease results from long-term elevated blood pressure, particularly in older adults.

This condition can lead to complications such as heart failure and coronary artery disease. Causes include genetic factors, poor diet, lack of exercise, smoking, and excessive alcohol consumption. Conditions like diabetes and high cholesterol can worsen hypertension.

Symptoms may include shortness of breath, fatigue, swelling in the legs or ankles, and chest pain, although these may not appear until significant damage has occurred.

Management includes medication to control blood pressure and treat underlying conditions, along with lifestyle changes such as a healthy diet, regular exercise, and quitting smoking. Regular monitoring by a doctor is also important.

If left untreated, complications may include heart failure, coronary artery disease, and arrhythmias (irregular heartbeats) due to structural changes in the heart.

Rheumatic heart disease

Rheumatic heart disease often begins with symptoms such as a sore throat or skin infections and is most commonly seen in people under the age of 25. It affects approximately 55 million people worldwide and causes around 360,000 deaths each year, primarily in low- and middle-income countries.

It is caused by the bacterium Streptococcus pyogenes, which spreads easily between individuals. The infection can trigger an immune response that damages body tissues, leading to inflammation and scarring of the heart valves. This initial condition is known as rheumatic fever, and the resulting heart damage is referred to as rheumatic heart disease.

Although preventable, limited access to healthcare in poorer regions increases the risk. The disease is also significant in pregnancy, where it can lead to complications such as arrhythmias or heart failure due to increased strain on the heart.

There is no cure for rheumatic heart disease, and valve damage is permanent. However, it can be prevented by treating infections early with antibiotics. Long-term prevention may involve regular antibiotic injections every 3–4 weeks over several years, although this can be difficult in areas with limited healthcare access.

In severe cases, surgery may be required. Without adequate treatment, the disease can lead to lifelong disability or death.

Conclusion

Many of the most prevalent heart diseases have diverse causes and serious effects. It is therefore important to research and understand these conditions, as they affect one of the most complex and vital organs in the human body.