What is cardiovascular disease?

Cardiovascular disease (CVD) affects the heart and its blood vessels. It is associated with the buildup of plaque inside the arteries (atherosclerosis) and an increased risk of blood clots, which can cause damage to the brain, heart, kidneys, and eyes.

• Worldwide, it claims 20.5 million lives every year, representing 32% of all global deaths, of which 85% are due to heart attack and stroke.
• Of the premature deaths due to non-communicable diseases of individuals under 70, 38% are due to CVD.
• More than 75% lives are lost in low- and poor-income countries due to CVD.
• Early diagnosis of the disease improves survival.

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CVD Epidemiology in India 

Men suffer more from the disease compared to women

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It is the leading cause of death in India

• Death statistics
  
  • 2001 to 2003: statistics reported 17% of total deaths and 26% of adult deaths
  • 2010 to 2013: reported an increase to 23% of total deaths and 32% of adult deaths
  • Projected rise in 2025: may be significantly high
• Prevalence
  
  • Urban from 1 percent to 9 to 10%
  • Rural increased from 1% to 4% to 6%

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Types of cardiovascular diseases

Cardiovascular disease refers to many conditions

• Heart disease
  
  • Heart and blood vessel diseases are collectively referred to as heart diseases. Atherosclerosis develops due to the buildup of plaque in the inner walls of arteries, which narrows them and causes difficulty with blood flow through them. A clot forms, blocking blood flow and potentially leading to a heart attack or stroke.

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• Stroke

The effect of a stroke can be permanent when brain cells die due to a lack of oxygen, and are never replaced. Usually, most brain cells do not die during a stroke, and so the damage is temporary; physical strength, speech, and memory gradually improve.

• It occurs when the blood supply to a part of the brain is cut off, resulting in loss of function, such as the ability to walk or talk.
• When a blood vessel bursts open in the brain, due to uncontrolled high blood pressure.

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FAST stands for 

• Face: Drooping to one side
• Arms: The patient is not able to lift his arms because of weakness or numbness
• Speech may be slurred, and there may be difficulty in talking
• Time should not be lost

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A transient ischaemic attack (TIA) is a mini stroke that is caused by a temporary reduction in the blood flow.      

• Heart failure

Heart failure means the heart isn’t pumping blood as well as it should. Even though it continues to function, it is unable to meet the body's need for blood and oxygen. Left untreated, it gets worse.

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• Arrhythmia

It is an abnormal heart rhythm.

• Bradycardia is characterized by a slow heart rate, typically defined as a heart rate of fewer than 60 beats per minute.

• Tachycardia is a fast heart rate, characterized by a heart rate exceeding 100 beats per minute.

• An irregular heartbeat makes it difficult for the heart to pump enough blood to meet the body’s needs.

• Heart valve problems
  
  • Stenosis occurs when the walls of the vessel narrow and don’t open completely. It affects the blood flow to the aorta and to the rest of the body.
  • Regurgitation is the backward flow of blood because the valves cannot close properly.
  • Prolapse is when the valve leaflets prolapse back into the upper chamber.

Signs and symptoms of heart disease

The symptoms depend on the cause. The older adults and women have subtle symptoms, even though they have serious cardiovascular disease.

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Symptoms of heart disease

• Chest pain
• Shortness of breath
• Dizziness or fainting
• Fatigue or exhaustion

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Symptoms of blockages in blood vessels throughout the body

• Cramps in the legs
• Sores in the leg that don’t heal
• Redness on legs
• Swelling in the legs
• Numbness of limb, arms, or face
• Difficulty in talking, seeing, or walking

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What causes cardiovascular disease?

The exact cause of cardiovascular disease is not clear, but there are several risk factors on which it depends.

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Risk factors

The more risk factors you have, the greater the chances of developing heart disease.

• High blood pressure damages the blood vessels.
• Smoking causes narrowing of blood vessels because of the harmful substances present in tobacco.
• High cholesterol narrows blood vessels due to deposition, thereby increasing the risk of developing a blood clot.
• Diabetes increases blood sugar levels in the blood vessels, causing them to become narrower. Individuals with type 2 diabetes are overweight or obese, which is also a risk factor for CVD.
• Chronic kidney disease (CKD) is a risk factor in patients with CVD
• Physical inactivity makes individuals overweight, increases their cholesterol levels, and increases the risk of developing CVD. Exercising regularly keeps the heart healthy
• Obesity is a risk factor for CVD. It increases the risk of developing diabetes and high blood pressure.
• Exercising regularly will help keep your heart healthy. When combined with a healthy diet, exercise can also help you maintain a healthy weight.
• Being overweight increases the chances of developing diabetes. 
• Family history is also an important risk factor for developing heart disease.
• Other risk factors
  
  • Age over 50 years
  • Gender: Men are more susceptible to CBD than women at an early age
  • An unhealthy diet leads to high cholesterol and blood pressure
  • Consuming alcohol causes weight gain, an increase in cholesterol, and an increase in blood pressure

Diagnosing cardiovascular disease

Some common tests for diagnosing cardiovascular disease are

• Medical History and Physical Examination
• The ankle-brachial index (ABI) compares blood pressure in the ankles and arms to diagnose peripheral artery disease.
• Blood tests such as blood cholesterol, blood sugar, and proteins
• An electrocardiogram (ECG) records the heart's electrical activity
• Ambulatory monitoring wearing fitness trackers that track heart rhythm and rate. 
• An echocardiogram creates images of the heart and blood flow
• Cardiac Computerized Tomography (CT), which creates 3D images of the heart and blood vessels
• Cardiac Magnetic Resonance Imaging (MRI) also creates detailed images of the heart using magnets and radio waves
• MR and CT angiograms use MRI or CT to see blood vessels in the legs and head to neck
• A stress test analyzes how the heart responds to physical stress.
• Cardiac catheterization uses a catheter, a hollow tube, to measure pressure and blood flow within the heart.

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‍Treatment and management

The treatment plan depends on the symptoms and type of cardiovascular disease you have

• Lifestyle changes include modifying your diet, increasing physical activity, and quitting smoking and using tobacco products.
• Medications depend on the cardiovascular disease you have.
• Surgical procedures advised may be stents in your arteries, minimally invasive surgery, open heart surgery, ablations, or cardioversion.
• Devices such as pacemakers should be implanted if required.
• Cardiac rehabilitation is an exercise program to help your heart get stronger.

Know your numbers

• Blood pressure should be monitored regularly as it is one of the biggest causes of heart attack and stroke.
• Blood cholesterol levels should be kept under control through a healthy diet and, if necessary, with medication.
• Maintain blood sugar levels and take every precaution to control them.

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Medications 

Prescribed medications should be taken regularly.

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Lowering the risk of cardiovascular disease through lifestyle

• Eating a healthy and balanced diet
  
  • A healthy diet should include unprocessed and fresh foods
  • Plenty of fruits and vegetables
  • Whole grains
  • Nuts and food low in saturated fat, sugar, and salt
  • Plenty of water
• Physical activity
  
  • Perform 30-minute moderate-intensity physical activity
  • Adults aged 18 to 65 should do 150 minutes of moderate intensity physical activity or 75 minutes of high intensity physical activity every week
  • For children and adolescents, 60 minutes of moderate to vigorous intensity workout every day is essential
  • Being active reduces stress, controls weight, and reduces risk factors for cardiovascular disease
• Healthy body weight
  
  • Reduce your calorie consumption and exercise regularly to maintain a healthy body weight.
•  Avoid tobacco and alcohol.
  
  •  Stop smoking and avoid smoke-filled environments. All forms of tobacco are harmful.
• Manage stress
  
  • Stress increases the risk of heart disease, especially in women. Exercising, deep breathing, and relaxing muscles manage stress.

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Cardio pulmonary resuscitation (CPR)

Heart attacks lead to cardiac arrest. CPR increases the chance of survival if a patient has sudden cardiac arrest and their heart stops beating. A CPR has continuous cycles of 30 chest compressions followed by two rescue breaths.

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CPR is effective only in an emergency. It should never be performed on individuals breathing normally. If the patient is noisy and frequent gaps in breathing can be heard, CPR can be performed.

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How physiotherapists help in CVD

Physiotherapists help heal the heart, maintain its strength, and prevent future problems by combining exercises with patient education and support. They help a patient on the road to recovery, prevention, and improve their quality of life.

• Cardiac rehabilitation
  
  • After an attack, surgery, or diagnosis of heart disease, they help in
  • Exercise training, education, and lifestyle support
  • It shortens hospital stay, reduces readmissions, reduces mortality, and improves quality of life

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• Exercise prescription
  
  • The designs safe exercise plans for heart patients

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• Long-term prevention
  
  • For those at risk, they provide early intervention with exercise and lifestyle advice.

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• Education and support
  
  • They teach patients how to monitor and recognize warning signs as they safely push their physical limits.
  • They help to build confidence and reduce anxiety after cardiac events.

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Future impact of CVD

By 2030, cardiovascular disease will affect 40.5% of the US population, which is a dramatic rise in prevalence. The annual health expenditure is also likely to triple, from $273 billion to $818 billion. The indirect cost, such as productivity, will also increase by 61%. This growing burden highlights the need to prevent the clinical and economic impact of CVD.

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Conclusion

Cardiovascular diseases (CVDs) are a group of heart and blood vessel diseases that include coronary heart disease, peripheral arterial disease, valve disease, congenital heart disease, cerebrovascular disease, and pulmonary embolism. CVDs will substantially increase the healthcare burden in the future; however, it is essential to remember that they are largely preventable. Our healthcare system should promote the prevention and early detection of diseases.