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Vascular disease: atherosclerosis - peripheral arterial occlusive disease (PAOD)
- What does disease mean for humans?
- How can a disease be identified and treated?
- Who needs to be examined?
Vascular disease: atherosclerosis - peripheral arterial occlusive disease (PAOD)
Heart attack and stroke are by far the most frequent causes of death in Austria. A common cause of these often catastrophic events is the vascular disease atherosclerosis, which causes narrowing of blood vessels. It is therefore also referred to as peripheral arterial occlusive disease (PAOD). Atherosclerosis, or in layman's terms, "blocked arteries", is an inflammatory disease which can affect all vascular areas of the body, and lead to vascular occlusions or circulatory disorders in affected organs. Vascular occlusions in the coronary vessels result in angina pectoris and myocardial infarction. Vascular occlusions on the brain vessels lead to stroke. Vascular occlusions in the leg arteries can result in intermittent claudication and "smoker's leg", the most common reason for amputations. Decline in performance and well-being, chronic illness, disability and high mortality are common to all vascular diseases. The disease often affects several vessel regions, so heart attack patients tend to have more frequent strokes, and vice versa. Smoking, diabetes, hypertension, increased blood lipids, excess weight and lack of exercise facilitate the development of atherosclerosis. Nevertheless, not all vascular diseases are explicable by these risk factors, and otherwise healthy individuals are affected by these diseases.
Advances in modern heart and vascular medicine now make it possible to diagnose early atherosclerosis, long before clinical events such as myocardial infarction or stroke occur. Non-invasive procedures such as blood tests, high-resolution ultrasound procedures and ultra-fast imaging techniques can be used to diagnose risk factors and early forms of vascular disease in all organs. Minimally invasive examination and treatment methods, such as the percutaneous catheter technique (heart & vascular catheters), can often eliminate circulatory disorders before irreversible damage to organs, myocardial infarction or stroke occur. Appropriate implementation of modern drugs allows for effective prevention of complications due to atherosclerosis. Even if atherosclerosis can not be cured today, optimal and early treatment allows for stabilization of the disease, and thus normal life expectancy and quality of life.
Therefore, patients should have a heart and vascular checkup to take advantage of the benefits of modern cardiovascular medicine not only if they have a history of tightness or pain in the chest, or difficulty breathing, but also if they have risk factors such as diabetes, hypertension, increased blood lipids and excess weight, or smokers and patients with heart or vascular diseases.Diseases of the coronary arteries - Angina pectoris and myocardial infarction: Coronary heart disease (CHD)
Heart attack is the most frequent cause of death in Austria, responsible for almost half of all deaths. Heart attack is caused by diseased and congested coronary vessels. Disease of the coronary vessels is known as coronary heart disease (CHD). These large coronary vessels - typically three - provide the heart with oxygen. Should constriction or occlusion of one or more coronary vessels occur, a condition known as angina pectoris (chest tightness, chest pain) or difficulty breathing can occur, as well as rhythm disturbances and circulatory collapse. In severe cases, death of the heart muscle tissue, and thus infarction, occur. The disease may be manifested by symptoms, initially under stress, later on also during rest or at night. However, a relatively large proportion of patients experience a heart attack without any prior warning signs. In a smaller number of patients, an infarction results in sudden cardiac death.
Such diseases can be indicated and diagnosed using various examinatons. These include laboratory tests, ECG, stress ECG (ergometry), CT scan, scintigraphy, and the most accurate examination of all: angiography (cardiac catheter examination). All patients with circulatory disorders require drug therapy. Although this does not correct the circulation disorder, it may inhibit progression of the disease, and reduces risk of myocardial infarction. Should a severe narrowing of the coronary vessels be diagnosed, and an angioplasty and stent implantation (to aid in keeping the artery open) can also be carried out at the time of the cardiac catheter examination, in order to remedy the disorder. For patients with acute myocardial infarction, this must be carried out within a few hours to keep the damage to the heart muscle at a minimum. Prompt relocation to a cardiological center with cardiac catheterization equipment is of the utmost importance. The aim, however, is to recognize the disease before an infarction occurs. Nowadays, such an event can frequently be prevented by combining various preventive measures. As an alternative to stent therapy, some patients require bypass surgery to improve heart perfusion.
Therefore, patients should have a heart and vascular checkup to take advantage of the benefits of modern cardiovascular medicine, not only if they have a history of tightness or pain in the chest or difficulty breathing, but also if they have risk factors such as diabetes, hypertension, increased blood lipids and excess weight, are smokers or have been diagnosed with heart or vascular disease.Diseases of the cerebral vessels and stroke: cerebral arterial occlusive disease
Stroke is the third most common cause of death in Austria after cardiac infarction and cancer, and the most common cause of permanent disability. Some consequences of stroke include visual or speech disturbances, paralysis of arms or legs, fine motor skill disturbances, confinement to bed, or care dependency. Warning signs of stroke can appear as temporary versions of the aforementioned symptoms. If these occur (referred to as transient ischemic attack or TIA), it is an alarm signal and the cause must immediately be assessed and treated in order to avoid an irreversible stroke. Unfortunately, very few strokes exhibit these warning signs. There are two types of strokes - those caused by a circulatory disorder (about 80%), and those caused by cerebral hemorrhage (20%). The most common causes of stroke due to circulatory disturbances are cardiac arrhythmias (atrial fibrillation) and constrictions of the carotid arteries (carotid artery stenosis). Disease of the cerebral vessels is also called cerebral arterial occlusive disease. While the treatment of stroke is handled by neurologists, early detection and treatment of its most common causes are performed by internists. Early detection of risk factors for stroke is of particular importance, as the treatment after a stroke may be problematic and patients often sustain irreversible damage.
Here, examination of the heart and brain vessels is of particular importance. The most significant causes of stroke can be detected by means of heart and vascular ultrasound, as well as ECG and long-term ECG examination (Holter ECG). Depending on the findings, appropriate prophylactic therapy may be initiated. This usually involves a type of blood dilution and, in selected cases, treatment of narrowing of the brain vessels (carotid stenosis). This can now be done using minimally invasive catheter technology. The traditional method for treating high-grade carotid stenosis is carotid surgery.
In the case of stroke, prevention is considered better than therapy. Patients exhibiting precursory signs of stroke such as blurred vision, speech disorders, paralysis of an arm or leg, or dizziness, as well as those with risk factors such as hypertension, diabetes, increased blood lipids and excess weight, smokers and patients with a family history of stroke should be examined.Diseases of the femoral arteries and intermittent claudication: peripheral arterial occlusive disease (PAOD)
Intermittent claudication is caused by a circulatory disorder of the femoral arteries. The disease is therefore called peripheral arterial occlusive disease (PAOD). Approximately 20% of patients over 65 have this circulatory disorder, but very few are aware of it. The disorder is often asymptomatic and causes little to no discomfort. Due to severe constriction of the femoral arteries, the leg muscles are poorly supplied with blood and oxygen under physical stress (walking, running, climbing stairs). This results in muscle aches and soreness in calf, thigh and buttock muscles. If the individual stands still, alleviating this physical stress, the symptoms disappear, only to return once further exertion occurs. At an advanced stage, circulation may worsen, causing a critical circulation disorder (critical leg ischemia). This disease can lead to amputation if left untreated. Critical circulatory disturbance is by far the most common cause for amputation in Austria.
PAOD can be detected and treated before amputation becomes necessary by means of vascular examinations, such as oscillography, Doppler and duplex sonography, and high-resolution imaging techniques. All patients with PAOD require drug therapy to prevent progression of the disease. If the patient suffers from severe discomfort due to an extreme vascular occlusion, an angioplasty can be performed using minimally invasive catheter technology (vascular catheter) or stent implantation (use of a vascular support) in order to improve circulation. An improvement in circulation is the main therapeutic goal, especially in patients with critical blood flow disorders. Surgical therapy (bypass) is also used as an alternative or supplement to catheter treatments.
Although PAOD is a common disease, it frequently goes undetected and is therefore often treated inadequately. In the presence of leg pain during physical exertion, a vascular checkup should be performed. If symptoms of a critical flow disturbance are present (eg cold, pale leg, pain in the area of the toes or the forefoot, non-healing wounds on the legs), a vascular checkup must be carried out expediently, in order to prevent possible amputation. All patients with diabetes should undergo a vascular checkup once a year, as a common and particularly dangerous form of PAOD can occur in the vessels of the lower leg, which has a very high amputation rate.Diseases of the aorta (aortic aneurysm, aortic dissection)
These diseases lead to an expansion of the main arteries (aortic aneurysm), and may occur with or without the inner layer of the aorta separating from the middle layer (dissection). The danger here lies in the rupturing or bursting of the aorta and related fatal hemorrhage. Aneurysms may also lead to circulatory disorders (especially in the presence of a dissection), or to occurrence of blood clots and their migration to various vascular regions (embolisms). The risk of rupturing (vascular tearing) increases in proportion to the diameter of the aneurysm. The limit values for treatment indication are 6cm for the aorta in the thoracic region (Aorta thoracalis) and 5.5cm for the aorta in the abdominal region (aorta abdominalis). If these limit values for maximum diameter are exceeded, the risk of rupture increases sharply, and a surgical treatment of the aneurysm should be considered. There are, however, numerous reasons to attempt surgery before these limit values are reached - especially if the aneurysm is painful or rapidly increases in size despite optimal therapy.
Depending on the location of the aneurysm, it can be diagnosed by ultrasound examination or by cross-sectional imaging (CT scan, MRI). Patients with aneurysms require drug therapy, usually with a mild blood thinner, for the prevention of clot formation as well as for antihypertensive therapy. If an aneurysm has to be treated surgically, the use of vascular supports (stent graft) or open surgery are options.
Patients with chest or abdominal pain should be examined for an aortic aneurysm, as well as patients with signs of embolism (clot migration). High risk patients with high blood pressure, smokers and patients in whose family history includes frequently occurring aneurysms should have an ultrasound examination.Cardiac arrhythmia
The term cardiac arrhythmia includes all electrical abnormalities of the heart, from harmless extra beats to life-threatening arrhythmias. Overall, cardiac arrhythmias occur very frequently. Harmless extra beats are occasionally observed in nearly all people, though they occur more frequently in some, and lead to symptoms of irregular heartbeats. Irregular heartbeats and rapid heartbeats can also be triggered by other cardiac arrhythmias such as atrial fibrillation. Atrial fibrillation is the most common, potentially dangerous rhythm disturbance, mainly because if left untreated, it can cause clots in the heart and thus trigger strokes. Rarely, other atrial tachycardia are causes of arrhythmia, and even less common malignant rhythm disturbances are cause of discomfort or even collapse conditions. With symptoms such as heart palpitations, rapid heartbeat, irregular heartbeat, collapse, difficultly breathing, or tightness in the chest, there is always the possibility of a rhythmic disturbance. Due to the large variety of rhythmic disorders and the very different prognosis (completely harmless to life-threatening), a distinction is extremely important to assess the need for therapy.
Indications of cardiac arrhythmia are usually symptoms and discomfort. Coincidentally discovered cardiac arrhythmias that do not cause any symptoms are usually harmless. The most important tool for the diagnosis of rhythmic disturbances is the ECG examination. This is usually supplemented by a long-term ECG examination (Holter ECG) as well as a stress ECG examination (ergometry). In order to recognize the cause of rhythmic disturbances, a heart ultrasound examination (echocardiography) and sometimes a heart catheter examination are necessary. The treatment of cardiac arrhythmia essentially depends on its cause. The treatment options are just as varied as these causes. Typically, cardiac arrhythmia is treated using medication. Often, high blood pressure must be treated as both a concurrent symptom and a cause. Occasionally, heart failure can be treated and the rhythm can be corrected. Sometimes a blood dilution must be performed to prevent clot formation due to the rhythmic disturbance. Some cardiac arrhythmias can be addressed with a special cardiac catheter treatment (catheter ablation).
Cardiac arrhythmia may cause symptoms such as heart palpitations, rapid heartbeat, irregular heartbeat, a stinging sensation in the chest, collapse, swelling of the legs, dizziness, difficulty breathing at rest or during exercise, tightness in the chest or general decrease in performance. Patients with hypertension, known hereditary diseases such as vascular disease, or circulatory disorders should have regular heart rhythm checkups.Heart valve disease
The human heart usually has four heart valves that regulate the direction of blood flow in the heart. All four heart valves can become diseased and develop constrictions (stenosis) or leakage (insufficiency) or both together (combined vitium). These disorders can occur at any age. Diseases of the heart valves can be harmless if they are degenerative symptoms (wear) and the degree of constriction or leakage is low. Severe heart valve changes can also lead to heart failure or cardiac death. Besides degenerative symptoms, causes of cardiac valve disease are mainly infections or congenital weaknesses of the valve apparatus. Some diseases of the heart muscle can also affect the heart valves. In the case of long term cardiac valve disease, cardiac muscle weakness may develop, especially if the valve disease remains unnoticed.
In addition to the auscultation of the heart (listening), the heart ultrasound examination (echocardiography) is the most important diagnostic measure for the detection of heart valve diseases. The heart ultrasound examination has largely replaced the previously often required cardiac catheter examination. The treatment of heart valve diseases can be performed in three ways: medically, surgically and interventionally. Many patients with heart valve disease require drug therapy, which can not improve or stop the disease itself, but alleviates symptoms and discomfort while improving function of the heart. In many severe cases, cardiac surgery is still the method of choice. During surgery, valves can be reconstructed or replaced. In the case of valve replacement, biological (cattle or pig heart valves) or artificial heart valves (metal prostheses) can be used, which both have advantages and disadvantages. In some patients with severe cardiac valve disease, valve replacement can now be performed using cardiac catheter technology.
Patients with ailments such as difficulty breathing (dyspnea), swelling of the legs, performance decline, pain or tightness in the chest, or collapse should be examined for heart valve disease. Patients diagnosed with a heart murmur should also have a heart ultrasound examination.Myocardial disease
The term myocardial disease includes a variety of possible conditions, that share a common weakness of the heart muscle. Patients with myocardial disease usually take this as a shortness of breath and performance decline, but leg swelling or water on the lungs (pulmonary edema, pulmonary congestion) may also occur. Frequent causes of heart disease are circulatory disorders, rhythmic disturbances or chronic hypertension. Rarely, past viral infections (myocarditis, inflammation of the heart muscle) are to blame. Heart disease can also be caused by heart valve defects.
The important factor in treatment of heart disease is finding its cause. The pumping performance of the heart is examined by heart ultrasound examination (echocardiography). By this method, many causes such as circulatory disorders or cardiac valve disease may also be recognized. Other diagnostic tools include ECG examinations are carried out during rest and exercise, blood pressure measurements, cross-sectional procedures (CT scan, MRI), scintigraphy and heart catheter examination.
Patients with dyspnea, leg swelling, performance decline or chest discomfort should be examined for myocardial disease. In addition, patients with known circulatory disorders of the heart, cardiac arrhythmia or cardiac valve diseases should be examined.Venous diseases and thrombosis
Venous diseases essentially are comprised of two types: one is an expansion of the veins with leakage of the venous lobes (insufficiency), the other a clogging of the veins (clot formation = thrombosis). Both diseases can be affected by deep or superficial veins, resulting either in chronic venous insufficiency (widening and dilatation of the deep veins) and varicose veins (widening and vascular weakness of the superficial veins), or deep venous thrombosis (blockage of deep veins) and thrombophlebitis (blockage and inflammation of superficial veins). In general, diseases of the deep veins are more serious, as they frequently lead to severe complications such as an ulcerated leg (venous ulcer, ulcus cruris) or a pulmonary infarction (pulmonary embolism). Risk factors for the development of thromboses are immobility (cast, bed confinement), smoking, birth control pills, tumor diseases and congenital blood clotting disorders.
In addition to the typical clinical profile ranging from pain, redness, swelling of the legs and enlarged veins to an ulcerated leg (venous ulcer), it is above all important to perform examinations such as an ultrasound. Laboratory examinations, and sometimes sectional imaging procedures or phlebographs (vein x-ray) are often used in diagnostics. A diagnosis of thrombosis also indicates that its cause should be investigated. Treatment of venous diseases is performed according to their causes: In the case of chronic venous insufficiency and varicose veins, compression therapy (support stockings, compression stockings) and physical measures are the main focus. In addition, certain venous drugs can be used. In selected patients, venous surgery can provide relief. In patients with venous thrombosis, on the other hand, blood dilution is provided as the most important measure in addition to compression therapy using bandages and compression stockings. The nature and duration of blood dilution depend on the location and extent of the thrombosis.
Pain and sudden swelling of the legs are always an alarm signal and require a rapid assessment to rule out thrombosis. Reddening and hardening of a vein strand is indicative of a superficial venous inflammation. Here, the deep veins must be examined by ultrasound in order to rule out a simultaneous deep vein thrombosis. Chronic ankle swelling and nocturnal leg cramps are typical signs of chronic venous insufficiency (widening and valve weakness of deep veins) and should also receive an angiological assessment.Pulmonary Embolism and Infarction
Pulmonary embolism is produced by the spread of a clot (thrombus) from the deep leg veins into the pulmonary veins (pulmonary embolism). This results in blockage of the pulmonary veins and formation of a lung infarction (= loss of lung tissue). This can cause cough, dyspnoea, chest pain, pneumonia but also sudden death, making pulmonary embolism a feared complication of leg vein thrombosis. Although pulmonary embolism is very common in patients with leg vein thrombosis (up to 50% of patients), most remain asymptomatic and are dissolved by the body. Frequently recurring pulmonary embolisms may cause pulmonary hypertension (a condition that can lead to cardiac stress), chronic dyspnoea, and impaired performance. Risk factors for pulmonary embolism are the same as for leg vein thrombosis, ie immobility (cast, bed confinement), smoking, birth control pills, tumor diseases and congenital blood clotting disorders.
Symptoms include dyspnoea, stinging and pain in the chest, rapid heartbeat, cough and performance decline. Pulmonary embolism may be inferred in pulmonary x-rays or cardiac ultrasound examinations. A reliable diagnosis is only possible by means of sectional imaging (CT scan) or by nuclear medical scintigraphy. Pulmonary embolism is treated using blood thinners. The duration depends on the circumstances. In addition, antibiotic therapy is often necessary to keep concomitant pulmonary infections in check.
Pulmonary embolism must always be considered with sudden symptoms such as dyspnoea, stinging or pain in the chest, cough or circulatory collapse, pulmonary embolism must always be considered, especially in high risk situations such as surgery or immobility. Patients with leg vein thrombosis have to be questioned and examined for symptoms of pulmonary embolism.Diabetes
Diabetes (diabetes mellitus) is a disease in which the blood glucose lowering hormone, insulin, is either not sufficiently produced in the pancreas (type I diabetes) or is not effective enough (type II diabetes). Type I diabetes usually occurs in adolescents or young adults, while type II diabetes (adult onset diabetes) is usually diagnosed only after the age of 50. Type II Diabetes is often associated with overweight, increased blood lipids and increased blood pressure - a combination called metabolic syndrome. An increase in blood glucose levels carries several dangers. In the case of very high blood sugar levels, as usually occur at the onset of the disease without therapy, diabetic coma can occur. This elevated blood sugar must be distinguished from the hypoglycemia, which may occur due to an overdosage of blood sugar reducing drugs. However, a diabetic coma due to elevated blood sugar levels is usually only anticipated at blood glucose values of over 500 mg / dL. In the long term, even lower blood glucose levels may damage different organ systems: the chronic increase of blood glucose may cause damage to the eyes (retinopathy), heart, brain and legs (angiopathy), nerves (neuropathy) and kidneys (nephropathy). Consequences of diabetes can therefore include myocardial infarction, stroke, amputation, loss of vision and renal failure. Such long term damage should be prevented by good blood glucose control.
Symptoms of sugar can be fatigue, exhaustion, thirst, increased amounts of urine, tendency to infection, blurred vision, dizziness or sweating. In many patients, however, the disease is insidious and remains asymptomatic for a long time. Therefore, diabetes should be ruled out by regular blood tests. The diagnosis of diabetes is made by performing a fasting blood glucose test. If it is elevated, a check should be carried out and long-term blood glucose (A1c) determined. In addition, an oral glucose tolerance test may be necessary to ensure the diagnosis. If diabetes is detected, a screening should be carried out to asess long term damage. This includes an examination of the heart and vessels, eyes, nerves, kidneys and lab tests. Diabetes can be treated using the following three measures: 1. Exercise, diet and weight optimization. 2. Blood glucose lowering medication and 3. Administration of insulin. Exercise, diet and weight optimization are important for all people with diabetes. Implementation of medication or insulin are dependent on the type of diabetes. Type I diabetics always need insulin therapy; for type II diabetics, both drugs and insulin can be used.
People with symptoms such as fatigue, exhaustion, thirst, increased amounts of urine, tendency toward infection, vision problems, dizziness or sweating should promptly undergo a fasting blood glucose test. In addition, blood glucose should be measured as part of an annual health examination. Patients with pre-existing diseases of the heart, vessels, nerves, eyes or kidneys should be examined very precisely for diabetes.Hypertension
High blood pressure (arterial hypertension) is when blood pressure increases above a certain limit value over the course of several measurements. Regardless of age, blood pressure should be at a maximum 135/85 mmHg. In patients with diabetes or renal disease, even lower values (120/80 mmHg) should be pursued. Constantly elevated blood pressure leads to stress and damage to the heart, vessels, eyes and kidneys, and can therefore lead to stroke, myocardial infarction, vision loss, peripheral arterial occlusive disease and kidney failure. To prevent these events, the permanently elevated blood pressure must be lowered. Many people do not feel increases in blood pressure. Hypertension usually develops slowly over the course of several years, so the body seems to grow accustomed to elevated blood pressure. However, this does not make the disease any less dangerous.
Since many patients do not feel elevated blood pressure, this can often only be observed by performing a blood pressure measurement. The blood pressure measurement should be carried out on both upper arms the first time, and should be repeated regularly, over a few days, especially if values are elevated. Alternatively, a 24 hour blood pressure measurement can be helpful and quickly help with a diagnosis. A single elevated blood pressure reading at the doctor's office can also occur in healthy individuals and should therefore be offset by patient self-measurement. If hypertension is detected, further evaluation of the heart and vessels should take place in order to detect already existing damage from hypertension, or to diagnose possible causes. Certain patients may have causes, such as hormonal disturbances or renal artery disease, that may be treated. In more than 90% of patients, however, there is no cause of hypertension, and a genetic burden (essential hypertension) must be blamed. The treatment of essential hypertension is administered by 2 measures: 1. Exercise, (low-salt) diet and weight optimization as well as 2. drug therapy. Exercise, diet and weight optimization are recommended for all patients with hypertension, as these measures reduce blood pressure and help to economize medication. Depending on the blood pressure values and response to these measures, individual drugs or preparations in combination may also be necessary. In patients with hormone disorders or constriction of renal arteries, treatment of these disorders can often improve or normalize blood pressure.
Symptoms of hypertension may include dizziness, blurred vision, pressure in head or chest, dyspnoea, or heart disease; in many patients, increased blood pressure remains asymptomatic. Therefore, a regular screening test including blood pressure measurement is recommended.Elevated blood lipid levels
Elevated blood lipids (cholesterol, triglycerides) are a significant risk factor for heart and vascular diseases. Increases in these values are virtually always symptomless, and do not cause any discomfort. An increase in blood lipid values is influenced by the supply of fats in food; the liver also produces cholesterol and triglycerides even with minimal consumption. For most people with elevated blood lipids, there is an overproduction of cholesterol and triglycerides in the liver, so that increased blood fat values are observed even with fat free diet. It is believed that this is the most common genetic disorder that affects approximately 1/4 of all adults. Cholesterol is comprised of bad (LDL) and good (HDL). Above all, an increase in LDL cholesterol leads to increased deposits (plaques) in vessels, and thus to the formation of bottlenecks or vessel occlusions. This can affect all vascular areas, but cardiac, brain and leg vessels (atherosclerosis) are particularly affected by this disease. The consequences may be myocardial infarction, stroke and peripheral arterial occlusive disease. The risk for the development of deposits increases with increasing LDL values, but it also depends on interaction with other risk factors (hypertension, diabetes, smoking). The recommended limit values for total and LDL cholesterol are therefore dependent on risk factors and pre-existing vessel damage, and differ from one patient to the next.
The diagnosis of elevated blood lipid values can only be carried out by means of a fasting laboratory examination. However, for the correct interpretation of measured values, additional tests are necessary: risks must be assessed, and the patient's blood vessels examined in order to determine the need for antihypertensive measures. In order to reduce blood lipids, two options are available: 1. All patients with elevated blood fat values should attempt to lower levels through movement, diet and weight reduction. Movement (sports) is also the most effective measure for increasing good (HDL) cholesterol, which acts as a protective factor for the vessels. 2. A number of medicinal blood lipid lowering agents are available, depending on blood lipid values and cardiovascular risk. The most commonly used preparations are statins, which reduce production of cholesterol and triglycerides in the liver, thereby lowering blood lipid levels. However, the special benefit of these medicines is also a favorable effect on cardiac and vascular disease. Statins reduce the progression of cardiac and vascular diseases, regardless of their effect on blood lipids.
As elevated blood lipid levels do not cause any discomfort, they should be determined regularly as part of a health checkup. In addition, patients with existing cardiac or vascular disease should be closely monitored for blood lipids in order to prevent these diseases from progressing by initiating drug therapy.Smoking
The inhalation of cigarette smoke harms the human organism in many ways. The two most important health problems are tumor disease and heart & vascular disease. Over 35 different types of cancer are affected by smoking. The most common is lung cancer, which is one of the most deadly types of cancer today, with a 5-year mortality rate of more than 70%. The harmful effects of smoking on the cardiovascular system are no less dangerous. Smoking fuels atherosclerosis, and can lead to the clinical consequences of myocardial infarction, stroke and smoker's leg.
There are no helpful screening examinations for most cigarette-associated tumor diseases, especially lung cancer. Once the cancer is diagnosed, it may already have metastasized. The situation regarding cardiac and vascular damage is somewhat different: in this case, health damage can be detected at an early stage by means of preventive examinations such as ECG, stress ECG, heart and vascular ultrasound examination and further diagnostics. The most important therapeutic measure is the cessation of smoking. In addition, the appropriate secondary conditions can be treated according to the clinical situation.
Smokers should undergo regular screening of the heart and blood vessels in addition to quitting smoking. This usually includes an ECG, stress ECG, heart and vascular ultrasound as well as a laboratory examination.Other vascular diseases: Raynaud syndrome, malformations and vasculitis
In addition to atherosclerotic vascular disease, there is a wide variety of other vascular changes, which can range from harmless functional disorders such as primary Raynaud's syndrome, to congenital vascular malformations, to inflammatory vascular disease.
The diagnosis depends on the symptoms and the presumed cause of the disease. Some diseases can be diagnosed only by clinical examination; other diseases require the full spectrum of an angiological specialist clinic.
Patients with any type of suspected circulatory disorder should have an angiological examination to ensure the diagnosis of vascular disease, as well as its prognosis.