Cardiovascular Health Among Adults

Introduction

Cardiovascular health can be defined as a healthy cardiovascular system which comprises a heart and blood vessels. Cardiovascular health in adults has to do with a healthy heart and healthy blood vessels in adult human beings.

The heart is in the chest and it is the pump of the circulatory system. In the normal condition, the heart beats an average of 72 times a minute (that is 4,320 times an hour and 103,680 times a day). Each heartbeat is accompanied by pumping out 70ml of oxygenated blood (blood that is rich in oxygen) through the aorta to all parts of the body, and therefore the heart circulates up to (70 x 72 x 60 x 24) = 7,257 litres (1,600 gallons) of blood a day. The aorta is the first outgoing major blood vessel in the body. Through an extensive network of arteries, the blood that the heart pumps into the circulatory system delivers oxygenated blood and important nutrients throughout your body. Blood also mops up metabolic wastes from all parts of the body to the organs of excretion. These organs are where these metabolic waste products are excreted. Deoxygenated blood from all parts of the body is returned to the heart through a network of blood vessels called veins. Deoxygenated blood is blood from which the oxygen the body requires has been taken up. It contains less oxygen than the blood that goes out of the heart. The heart then circulates the deoxygenated blood that returns from all parts of the body to the lungs through a network of blood vessels called pulmonary arteries. In the lungs, carbon dioxide is removed and oxygen is added to the blood so that the blood becomes oxygenated again. The oxygenated blood is returned to the heart through another network of blood vessels called pulmonary veins.

The blood that is pumped by the heart through the circulatory system must be healthy in terms of quantity and quality. Insufficient quantity may lead to hypovolaemic shock, multi-organ damage, and death. Sub-optimal quality may lead to anaemic heart failure. Another abnormality may allow blood to clot and block blood vessels in various parts of the body including the arteries in the heart, lung, brain, kidneys, and limbs.

The perfect state or condition in the above system is what characterises cardiovascular health in a healthy adult.

What are the various cardiovascular health problems?

Angina pectoris: Angina is chest pain or discomfort caused by insufficient blood flow and oxygen to the muscle of the heart. In most cases the lack of blood flow is due to a narrowing of the coronary arteries – the arteries that supply blood to the heart. Angina usually occurs during much physical exertion, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood and oxygen than the narrowed coronary arteries can deliver to the heart.

Arrhythmia (abnormal heartbeat): Arrhythmias are abnormal heartbeats and can happen when the heart’s electrical system malfunctions or breaks down. This may be a symptom of underlying coronary heart disease or other medical problems. Tachy-arrhythmias like ventricular fibrillation can cause sudden cardiac arrest. Tachyarrhythmias are heartbeats that are both abnormally fast and abnormally irregular – they are, therefore, abnormal in speed/rate and rhythm.

Coronary heart disease: The underlying cause of coronary heart disease (also known as coronary artery disease) is when the coronary arteries become narrowed due to a slow buildup of fatty deposits, called “plaques” or “atheromas.” As mentioned earlier, coronary arteries are the blood vessels that supply the heart with blood. These fatty deposits gradually clog the arteries and reduce the flow of blood to the heart. This process of fatty deposit in the all of arteries is called atherosclerosis. It begins when people are young and can be well advanced by middle age. This may lead to symptoms such as angina pectoris. Coronary heart disease is the most common cause of death in Australia. It is also a major cause of disability, with many people reporting problems or needing assistance with daily activities.

Heart attack: The heart is a muscular pump that needs a continuous supply of oxygen. It gets oxygen from the blood which flows to the heart muscle through coronary arteries. These arteries run on the surface of the heart. A heart attack happens when there is a sudden complete blockage of an artery that supplies blood to an area of the heart. As a result, some of the heart muscle begins to die. Without early medical treatment, this damage can be permanent. A heart attack is sometimes referred to as a myocardial infarction, acute myocardial infarction, coronary occlusion, or coronary thrombosis.

Heart failure: Heart failure occurs when the heart muscle has become too weak to effectively pump blood through the body unlike what happens in a normal, healthy, heart. This causes blood to dam up on its way to the heart. This makes fluid to collect (oedema) in the lungs and tissues in other parts of the body like the feet, ankles, and legs. Heart failure is associated with a decreased stroke volume (the amount of blood that the heart pumps with every heartbeat). There is also inadequate cardiac output (the amount of blood that the heart pumps every minute). These decreases may lead several types of shock. Examples are cardiogenic shock (shock that is from a poorly functioning heart), cerebral ischaemia (shock from too little blood supply to the brain), and hypoxia (shock from too little oxygen in the blood that gets to the brain), loss of consciousness, and death.

Peripheral artery disease: Peripheral artery disease (also called peripheral arterial disease) is a condition in which the arteries in the upper and lower limbs are narrowed thereby reducing blood flow to the arms or legs. It is usually a sign of a buildup of fatty deposits in the arteries (atherosclerosis). Atherosclerosis causes narrowing of the affected arteries. The result is reduced blood flow in the legs and, sometimes, the arms. In peripheral artery disease, the legs, or arms — usually the legs — do not receive enough blood flow to keep up with demand. This may cause claudication (leg pain when walking) and may eventually cause death of toes or leg(s).

What are the symptoms of cardiovascular diseases?

The symptoms of cardiovascular diseases are many. They include:

• Chest pain
• Shortness of breath
• Fatigue on doing small work or exercise
• Dizziness
• Nausea (feeling of being about to vomit)
• Swollen ankles
• Arrhythmia
• Heart palpitations
• Numbness
• Sweating
• Fainting
• Indigestion – and many people misinintepret heart problems as “tummy” problems
• Jaw or back pain
• Leg pain
• Leg swelling
• Arm pain.

The medical doctor will give explanation for any of the symptoms that you report about yourself, your child, spouse, parent, or any other patient – related or unrelated.

What are the risk factors and causes for development of cardiovascular health problems?

Risk factors may be modifiable or non-modifiable.

High blood pressure: Blood pressure is the pressure of blood against the inner walls of arteries as the heart  pumps blood around the body. As the heart pumps, the flow of blood in the arteries and the blood pressure rises and falls in a regular wave pattern. Blood pressure peaks when the heart pumps (called systole) and falls when the heart relaxes (called diastole). If for example your blood pressure is 125/78mmHg, the number on top is systolic blood pressure and the number below is diastolic blood pressure. The number on top is always higher than the number below. Hypertension (High blood pressure) can lead to serious cardiovascular health problems, such as a heart attack, a stroke, and heart failure.

High blood cholesterol: Cholesterol is a fatty substance that the body produces naturally. It is found in the blood. Cholesterol is in some foods and we can get it into our bodies from such foods. It is used for many different processes in the body but causes cardiovascular health problems when there is too much of it in the blood. Too much cholesterol in the blood causes fatty deposits to gradually build up in blood vessels. This makes it harder for blood to flow through; this can cause a heart attack or stroke.

Diabetes mellitus: Diabetes mellitus (or simply, diabetes) is a chronic health condition where the body has difficulty processing the carbohydrates in food. This happens when the pancreas does not make enough insulin. It also happens when the insulin it produces is ineffective or a combination of both. When carbohydrates, such as sugar, rice, and bread are eaten, the body digests them (breaks them down) into glucose which enters the bloodstream and travels around the body. Insulin is a hormone that is responsible for helping glucose move from the blood into the body’s cells where it is used for energy. When insulin is not present or is ineffective, glucose builds up in the blood and causes micro-angiopathy (damage to small blood vessels) and macro-angiopathy (damage to large blood vessels).

Familial hypercholesterolaemia: Familial hypercholesterolaemia is an inherited disorder. In this condition, the liver’s ability to remove low-density lipoprotein (LDL) cholesterol – commonly known as bad cholesterol – from the blood is impaired. This results in high blood cholesterol levels. Without early diagnosis and treatment, this cholesterol will build up in the arteries, increasing the individual’s risk of premature coronary artery disease, heart attack, and early death. In people with familial hypercholesterolaemia, this build-up begins in childhood. This is why checkups that lead to early detection and treatment are so important.

Cardiomyopathy: Cardiomyopathy is a condition in which the heart muscle becomes inflamed and enlarged. Being enlarged, the heart muscle layer is stretched and becomes weak. This means that the heart cannot pump blood as well as it should. If the heart muscle layer becomes too weak, the patient may develop heart failure. Most people are only mildly affected by cardiomyopathy and can lead relatively normal lives. However, people who have severe heart failure may need a heart transplant.

What are some of the complications of cardiovascular health problems?

Cardiovascular health problems can cause complications in different organs in the body.

• Effect in the brain can cause stroke
• Effect in the heart itself can cause heart attack and cardiac arrest
• Effect in peripheral arteries can cause gangrene (e.g., death of a leg – it becomes black).

What Medical tests are needed to diagnose cardiovascular health problems?

1. Blood tests: When the heart muscle has been damaged, as in a heart attack, the body releases substances into the blood. Blood tests can measure the substances and show if, and how much of, the heart muscle has been damaged. Blood tests are also done to measure the level of other substances in the blood, such as blood fats (e.g. cholesterol and triglycerides), vitamins, and minerals. Blood sample is taken from a vein in the arm. A laboratory then tests it and sends the results to the doctor, who will interpret the results and explain to the patient.
2. Chest X-rays: Chest X-rays use a special type of radiation to take pictures of the chest, including the heart, lungs, airway, and blood vessels. The person is placed between the X-ray tube and a receiving plate which makes the picture. Chest X-rays are the most common X-rays performed.
3. Electrocardiogram (ECG): An ECG reads the heart’s electrical impulses. It shows how well the heart is beating. Small sticky dots and wire leads are put on the chest, arms, and legs. These leads are attached to an ECG machine which records the electrical impulses and prints them out on paper. The doctor may use an ECG to diagnose a heart attack or arrhythmias (abnormal heart rhythms).
4. 4. Exercise stress test: A stress test, sometimes called a “treadmill” or “exercise” test, is a type of ECG that is done while the person is exercising. It helps the doctor to find out how well the person’s heart works when they are physically active.
5. Echocardiogram (Ultrasound): An echocardiogram is a common test. It gives a picture of the heart using ultrasound waves. It uses a probe either on the chest or down the oesophagus (gullet). It helps the doctor check if there are any problems with a person’s heart valves and heart chambers. It also assesses how well the heart pumps blood.
6. Nuclear cardiac stress test: This test is sometimes called an “exercise thallium scan,” a “dual isotope treadmill,” or an “exercise nuclear scan.” A radioactive substance called a “tracer” is injected into the patient’s bloodstream. It goes to the heart and releases energy. Special cameras take a picture of this energy from outside the body. The specialist doctor uses this picture to see how much blood flows to the heart muscle and how well the heart pumps blood when the patient is resting and when doing physical activity. This test also helps the doctor to see if the heart muscle is damaged.
7. Coronary angiogram: A coronary angiogram, sometimes called “cardiac catheterisation,” may be done after a heart attack or angina. A catheter (a narrow but long tube) is put into an artery in the upper part of the thigh, the arm, or wrist. The catheter is moved up inside the artery until it reaches the heart. A special dye is injected into the coronary arteries and an X-ray is taken. The X-ray shows the doctor where and how much the coronary arteries are clogged or blocked. It also shows how well the heart is pumping. Coronary angiograms help the doctor decide the best treatment.
8. Magnetic resonance imaging (MRI): An MRI uses very strong magnets and radio waves to create detailed images of the heart on a computer. It can take still or moving pictures of the heart. Sometimes a special dye is used to make parts of the heart and coronary arteries easier to see. This test shows the doctor the structure of the heart and how well it is working, so the best treatment can be decided.
9. Coronary computed tomography angiogram (CCTA): This is a special type of computed tomography (CT) scan that may be used to help diagnose coronary artery disease. It is a non-invasive test for people who may be experiencing unusual cardiac symptoms.
10. Angiogram: An angiogram uses X-rays and a special contrast dye to take pictures of the arteries in the body. The dye is injected into a small tube or catheter into an artery in the groin or (sometimes) the arm. After the dye is injected, pictures are taken using an X-ray machine. Coronary angiogram discussed in number 7 concentrates on the arteries of the heart.

How are cardiovascular health problems treated?

The treatment of cardiovascular health problems depends on the type. Following evaluation, examination, investigations and diagnosis, the doctor decides on the appropriate treatment.

How to live long with a cardiovascular health problem

The following are important for long life despite the presence of cardiovascular disease:

1. Cardiac rehabilitation: Cardiac rehabilitation is a professionally supervised programme to support the patient and family or care-givers to manage the heart problems like coronary heart disease. A rehabilitation program covers the various physical, emotional, psychological, sexual, and work-related changes that the patient may go through.
2. Managing emotions: It is normal to have a lot of different feelings after a heart attack or other heart conditions. For example feeling sad, worried, stressed, angry, lonely, or guilty. These feelings are normal and do not usually last long. Talking to others, such as the doctor, cardiac rehabilitation team, family, and friends, help the patient feel better. Depression happens in people with coronary heart disease more than other people. People with depression usually feel sad, “down” or miserable most of the time, and find it hard to do normal activities. Talking to the doctor about treatments is highly recommended. The heart specialist may call in another specialist.
3. Life after a heart attack: For the first few weeks, it may be helpful to have someone close by for support and help. For people living alone, someone may need to stay with them during this time, depending on how serious the health problem is. Otherwise, help should be sought from a home care agency. Lots of rest are needed, but effort should be made to get back into a normal routine as soon as possible. Having a heart attack is not a “death sentence” but usually a “wake-up call” health-wise.

Prevention of cardiovascular health problems in adults

1. Avoid drinking alcohol in excess: Harmful drinking can occur in the short term (drinking too much on one occasion) or long term (drinking too much on a regular basis).
2. Avoid cigarette smoking: Chemicals in cigarette smoke cause the blood to thicken and form clots inside veins and arteries. Blockage from a clot can lead to a heart attack and sudden death. Chemicals in cigarette smoke can also cause the cells that line blood vessels to become swollen and inflamed. This can narrow the blood vessels and can lead to many cardiovascular diseases.
3. Cultivate habit of healthy eating: Healthy eating means eating a wide variety of foods from each of the 5 major food groups, in the amounts recommended by the doctor. Eating a variety of foods from the 5 major food groups is recommended. The groups are Carbohydrates, Proteins, Fats, Dairy and dairy products, and Fruits and vegetables. Healthy eating provides a range of nutrients to the body, promotes good health, and can help reduce the risk of cardiovascular disease. It also keeps the diet interesting with different flavours and textures. It is more cost effective than having a heart attack and treatment after the heart attack.
4. Ensure healthy bodyweight: A healthy bodyweight can help prevent and control high blood pressure, manage cholesterol and diabetes, as well as reduce the risk of cancer and heart disease. Healthy bodyweight depends on the person’s height. It is calculated as body mass index (BMI) and interpreted as below:

BMI (kg/m²)               Weight Status

<18.5                            Underweight

18.5–24.9                     Healthy Weight

25.0–29.9                     Overweight

≥30.0                            Obesity

5. Maintain physical activity: Physical activity is anything that is associated with moving and increasing breathing and heartbeat. Being active is a great way to help lead a healthier and happier life. It is important for healthy growth and development, reducing the risk of major illnesses, and increasing your chances of living longer.
6. Ensure regular medical checks: Over the years, the heart, like all other organs, loses functionality and undergoes ageing. In addition, cardiovascular risk factors that are outside the heart itself, such as hypertension and hypercholesterolemia (high levels of cholesterol in the blood), affect the heart and can put it in danger. This is why regular medical check-ups must be done. Cardiovascular prevention and healthy habits are very important to maintain a healthy heart. Good habits in childhood can improve cardiovascular health in adulthood by up to 35%, so prevention must start when childhood. A blood test that evaluates the blood lipids – cholesterol and triglycerides – as well as renal (kidney) function and an annual electrocardiogram, are some of the methods used to monitor health and prevent or reduce cardiovascular risk. Tests such as cardiac stress testing, used to assess the heart’s response to stress, or an echocardiogram, which provides a moving image of the heart, should be performed on people who have had a disorder detected either in their medical history or by physical examination at the doctor’s practice.

Conclusion

Cardiovascular health in adults over 40 years should be considered seriously especially in people with a family history of cardiovascular disease. Timely visit to hospital for early evaluation, diagnosis, and commencement of treatment should be the target in all instances.

References

1. https://chronicdisease.org/page/cardiovascularhealth/#:~:text=Cardiovascular%20health%20refers%20to%20the,arrhythmias%2C%20and%20heart%20valve%20problems