CARDIOVASCULAR SCREENING AND CARDIOVASCULAR DISEASE
Definition of CVD
Cardiovascular diseases (CVDs) are disease of the heart and blood vessels and include coronary artery disease, cerebrovascular disease, rheumatic heart disease and other conditions.
17.5 million People die each year from CVDs, an estimated 31% of all deaths worldwide. 80% of all CVD death is due to heart attacks and strokes
The cardiovascular system is made up of the heart and blood vessels. The heart pumps blood rich in oxygen and nutrient to all the organs of the body through the arteries. It also receives deoxygenated blood from body organs through the veins for onward transmission to the lungs.
Heart disease
The heart is a hollow organ with wall, chambers and valves. The wall is made of 3 layers
- Outer cover called pericardium
- Middle layer called myocardium
- And inner layer called endocardium
The pericardium can be affected by inflammatory process a condition called pericarditis. Pericarditis can result in accumulation of fluid around the heart. This fluid collection can compress the heart and affect its ability to pump effectively.
The myocardium can be affected by various disease conditions including hypertension and diabetes resulting in heart failure. When heart failure sets in, breathing becomes very difficult. This can initially be on moderate exertion but eventually it occurs at rest.
The endocardium and heart valves can be damaged by infection, non infective inflammatory condition, hypertension, age related process etc. This can result in impairment of blood flow within the heart and heart failure.
Disease of blood vessels
The lining the blood vessels can be narrowed by cholesterol deposit (Atherosclerosis) and any inflammatory process.
This narrowing will result in the reduction of blood flow to the organ supplied by the vessel. Blood flow to such organ can also be totally occluded. When this occurs, there will be acute ischaemia leading to cell death in the affected organ.
If this occurs in the brain, it causes stroke. If it affects the blood vessels of the heart, it results in heart attack.
Risk of developing cardiovascular disease
The tendency to develop various condition that affect the cardiovascular system is determined by the presence of risk factors.
These risk factors include
- Hypertension
- Diabetes
- Elevated blood cholesterol
- Obesity
- Sedentary life style
- Family history of cardiovascular disease
- Age 40yrs and above
- Smoking
- Excessive alcohol consumption
How can cardiovascular disease be prevented?
Cardiovascular disease can be prevented by
- Screening for the presence of these risk factors
- Evidence base management of these risk factors when they exist.
- Lifestyle changes to reduce overall cardiovascular risk
Cardiovascular screening
This involve
- Detail clinical history including family and social history
- Comprehensive physical and cardiovascular examination
- Complete metabolic panel to search for metabolic abnormalities that can affect the cardiovascular system.
- Resting electrocardiogram (ECG).
This can be used to detect abnormal electrical conduction within the heart and evidence of strain or previous insult from ischemia
- Stress ECG
This involve application of stress to the heart by means of graded exercise usually thread mill exercise. This can unearth evidence of impaired blood supply to the heart (ischemia) Which may not manifest at rest.
- Echocardiography
This will be used to examine the structure of the heart, the size of the chambers, the contractile function of the heart and the heart valves.
At the end of the cardiovascular screening excise the individual will be categories into one of 3 categories.
- Low risk
- Inter mediate risk
- High risk
Addition investigation may be carried out on those with intermediate and high risk
This may involve:
- 24 hours ambulatory ECG to monitor the heart for occurrence of abnormal heart rhythm which may be a precursor for sudden cardiac arrest.
- Stress Echocardiography. This is reserved for individual who cannot exercise on thread mill or have inconclusive result on thread mill test.
For further confirmation or enquiries, discuss with your Doctor or visit us at TAAL Specialist Hospital.
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