Hearts 101: Cardiovascular Disease… Beyond the Heart

Written By Connie Jorsvik

“Empowerment is having the tools and the insight to make changes to improve your health and make them stick.” Dr. Sarah Szal

Sick hearts get a whole lot of attention, but all the things that cause heart disease are often misunderstood and underestimated. For instance, high blood pressure just seems to be a right of passage as we age, but most of us know little about it other than the water pill or beta-blocker that was ordered. A diagnosis of diabetes is so common that it just seems normal, but even well-controlled blood sugars will lead to cardiovascular disease.

My hope is that the following explanations and resources help you understand the risk factors in ways you didn't before.

 

Risk Factors for Cardiovascular Disease

(in no particular order)

Genetic Predisposition

Genetics load the gun, and lifestyle pulls the trigger

We are learning more about genetic risk factors for heart disease and cardiovascular disease all of the time. With the advent of AI, we are likely to move at lightning speed to understand how mutations of genes can impact the likelihood of developing specific vascular diseases. if there is a strong family history of cardiovascular disease, it is important to have thorough screening and, if possible, genetic testing. At-home genetic testing kits such as CRIgenetics and 23andMe are often a good place to start.

Here are a few heart and cardiovascular diseases with a strong genetic component: heart disease that develops before the age of 50 especially if a first-degree relative has died of a heart attack or stroke, high cholesterol levels that are not linked to diet or lifestyle factors, Atrial Fibrillation, Brugada Syndrome, Long QT syndrome and Short QT syndrome.

 

Hypertension (high blood pressure)

Imagine a brand-new garden hose that is empty of water and is soft and pliable; if you want to extend the life of the hose, you allow it to drain between uses. Now, imagine an old, kinked hose where water pressures have been continuous. The water does not flow properly and might not flow at all, and the rigid walls are more likely to cause leaks (aneurysms). 

Hypertension is due to inefficient relaxation of the artery walls due to high fluid volumes and rigidity. 

It is a leading cause of heart failure and intracerebral bleeding (stroke). If the heart is continuously having to push against high pressures, it can lead to heart failure. It can lead to strokes because brain vessels are small and fragile. The vessels might spring a leak (like that old, brittle garden hose), causing potentially deadly intracerebral bleeding.

Blood pressure is measured in millimetres of mercury  or mm Hg (the silver fluid inside old-fashioned blood pressure machines.)

When you take your blood pressure, there are two important numbers: the top number is called 'systolic' (pronounced siss-tall-ic), and the bottom number is called 'diastolic' (die-ass-tall-ic). Systolic is the pressure inside the arteries as the heart pushes blood out to the body. Diastolic is the pressure in the arteries at rest. 

The optimal blood pressure is 120 over 80 = 120/80. The bottom number is the most important as it is vital to have the arteries relax and largely empty between heartbeats to reduce the workload of the heart and to keep arteries healthy and pliable. 

  • Stage 1 is 120-129 over 80 to 89.

  • Stage 2 is 130-139 over 90 or higher

  • Hypertension Crisis is anything higher than 180/120.

Causes: Hypertension doesn't always have a clear cause but can be influenced by prolonged stress, age, family history, a diet high in salt (increasing blood volume) and processed foods, smoking and a sedentary lifestyle.

Interventions include stress reduction (easier said than done), quitting smoking, eating a healthy diet with low salt intake, and exercising. If these are not enough to reduce blood pressure, medications will be needed.

 

Insulin Resistance (Type 2 Diabetes)

More than one in 10 people have diabetes, which is all about sugar control. Insulin is a hormone produced by the pancreas. It is like a key that opens the door to tissue cells, allowing glucose to enter and provide energy.

Type 1 Diabetes is an autoimmune disease where the pancreas produces no insulin. 

However, in Type 2 Diabetes, tissue cells become resistant to insulin, and blood sugar continues to circulate in the bloodstream. High levels of circulating blood sugar are irritating and cause blood vessel injury, which decreases oxygen delivery to the tissue. Even well-controlled diabetes affects all body tissues, but it is especially damaging to the tiniest blood vessels in the brain and retinas at the back of our eyes. It causes irreversible damage and infections in the feet and legs and is the leading reason for amputation.  

The cause of Type 2 Diabetes is nearly always high sugar intake and obesity. Interventions such as dietary management, exercise, and medications are often needed.

 

Obesity as Related to Type 2 Diabetes

As body fat accumulates, the risk of developing type 2 diabetes increases. The cellular and physiological mechanisms responsible for this link are complex and involve alterations in B-cell function, adipose (fat) tissue biology, and multi-organ insulin resistance. Adequate weight loss can normalize most of these.

 

Elevated LDL Cholesterol and Triglycerides

When you get blood work done and cholesterol levels are ordered, there are three things your primary care practitioners looking for. Your HDL is high-density lipids and they are your good cholesterol; think of the H as healthy. LDL cholesterol is low-density lipids; think of the L as lethal. The third number that your primary care practitioner is looking for is triglycerides. They are the most common type of fat in the body, and they store excess energy. High triglyceride levels combined with high LDL levels are linked with fatty buildups within the artery walls, which increase the risk of heart attack and stroke. 

Interventions include dietary changes, l osing weight to a healthy body mass index, limiting foods high in saturated fat, eliminating trans fats (found in many processed foods and snacks), choosing foods that are low in saturated fats, salt and added sugars, and eating foods that are naturally high in fibre. If you smoke, quit. Reduce or stop alcohol consumption. Increase regular physical activity to maintain a healthy weight and lower your cholesterol and blood pressure levels. Often, medications called statins are given to reduce LDL and triglyceride levels.

 

Metabolic Syndrome

Metabolic syndrome is a serious cluster of disorders that increases your risk of heart disease and stroke. The cluster includes increased blood pressure, high blood sugars, excess body fat around the waist (known as an apple body) and abnormal cholesterol and triglyceride levels. The more of these disorders you have, the higher your risk of heart disease and stroke. 

Interventions include a thorough physical with, at the very least, blood work and an ECG. Radical lifestyle changes are needed: lose weight, eat a healthy diet, control blood sugar, and control blood pressure. You should be referred to a professional, monitored heart health clinic.

 

Smoking

The chemicals that are produced when smoking cigarettes, vaping, and smoking marijuana are distributed throughout your body. They cause widespread damage to the innermost layers of your arteries and veins. People who smoke are much more likely to develop atherosclerosis, which is the plaque buildup within the arteries. Any amount of smoking can cause damage. some people are at greater risk, especially women who use birth control and people with diabetes.

Intervention is both simple and extremely difficult. If you smoke, quit. There are amazing resources and medications that are free, and the first place to start is at your local pharmacy, where smoking cessation programs are in place. 

 

Sedentary Lifestyle

Those who do not exercise regularly have a 30% to 50% greater risk of developing high blood pressure and all forms of cardiovascular disease. This risk is the same as that of cigarette smoking, high blood pressure, and elevated cholesterol. By being physically active, you reduce your risk of developing cardiovascular disease, and if you need to have surgery, you will recover faster.

A sedentary lifestyle is when an adult reports very little physical activity or less than 20 minutes three times per week. The more exercise an adult does, the higher the reported benefit and the lower the chance of serious cardiovascular disease.

 

The Cardiovascular System… Beyond the Heart

Carotid Arteries

The system of arteries and veins supplying the brain is nothing short of miraculous. There is redundancy built into every system just in case blood flow is disrupted going in or going out. There are two carotid arteries, one on each side of the trachea (windpipe). They are largely self-cleaning, and it takes a lot for plaque buildup to form, but when it does, it can cause decreased blood flow to the brain. If plaque breaks open, clots can form, and both the plaque and blood clot can move to the brain, causing a life-threatening stroke.

If you have any of the risk factors for cardiovascular disease, especially if you have been diagnosed with heart disease, it is important to have your primary care practitioner listen to the arteries for a 'bruit’ (broo-EE, which is a whooshing sound), an ultrasound or medical imaging (CT Scan or MRI) to determine if you have carotid disease. 

Interventions can be lifestyle management, medications, and, if blockages are significant, an endarterectomy (surgical removal of the plaque) or a stent may be inserted.

 

The Brain

There are two types of Stroke:

  1. Occlusion of arteries due to narrowing arteries or a clot (that may have travelled from any other part of the body).

  2. Intracerebral bleeding due to the rupture of a blood vessel. Surgery is often needed

Bloodwork called a D-Dimer, can detect the presence of proteins that indicate a clotting problem is happening. If D-Dimer levels are high, it may be presumed that a stroke has occurred. However, the only definitive way to determine the difference before providing emergency treatment or surgery is by a CT scan. 

Arterial disease of the brain: When plaques develop in the carotid arteries that send oxygen to the brain, blood flow can be constructed, causing diminished oxygen to vital brain tissue. If plaque comes loose anywhere in the body, it travels to the brain, causing transient ischemic attacks (like heart angina), or strokes occur when clots form. In the brain itself, plaques can cause low oxygen and cellular death or blockages, causing transient ischemic attacks (TIAs or mini-strokes) or stroke. 

TIAs, while often fleeting, should be seen as a warning sign for a larger, serious stroke. Strokes always cause brain damage in the area affected and can cause life-altering changes and death.

Interventions: Strokes must be treated immediately; they are a life-threatening crisis. If the stroke is due to a clot, clot-busting medications are given.

 

Aneurysms

An aneurysm is a weakening or rupture of an artery wall. The bigger the vessel, the more lethal the aneurysm will be. An aneurysm can occur in any artery in the body but is most common in the brain and the large arteries feeding organs and the legs. 

When an aneurysm bursts in the brain, it causes an intra-cerebral bleed that can be immediately deadly. The symptom is usually described as pain that is the worst in the person's life. Call 911!

One of the most common aneurysms that is associated with cardiovascular disease is an aortic aneurysm. The aorta is the biggest artery in the body and it is under tremendous loads. It takes a toll from the inflammation of diabetes and/or smoking, high blood pressure, and the build-up of plaque. 

Aneurysms are silent until they begin to rupture (picture a balloon off the side of a hose) or they completely rupture. A complete rupture of an aortic aneurysm is almost always fatal. If caught early, surgical interventions might be offered. 

If you have a diagnosis of the triad of diabetes, hypertension, and coronary artery disease, routine ultrasounds should be considered. 

Time is Tissue! Call 911!

 

Peripheral Artery Disease (PAD)

PAD Warning Signs

  • Erectile Dysfunction (ED)

  • Retinopathy: deterioration of the retinas at the back of the eyes

  • Intermittent Claudication (pain, aching and heaviness of the legs with exercise)

  • Restless Leg Syndrome (RLS)

  • Infections and cellulitis (skin infections) of the lower legs and feet

 

Erectile Dysfunction (ED)

Vascular erectile dysfunction and cardiovascular disease share common risk factors, including obesity, high blood pressure, metabolic syndrome, and Type 2 Diabetes. They have common underlying pathological mechanisms, including damage to the endothelium of blood vessels, inflammation, and hardening of the arteries (atherosclerosis). There is evidence that erectile dysfunction is an independent predictor of future cardiovascular events. 

All men experiencing ED should be thoroughly screened for all potential causes, including cardiovascular disease. Erection medications should be avoided when taking certain heart medications, so talk to your primary care practitioner.

 

Retinal Disease

Within the retina, there's an intricate system of arteries, capillaries and veins that deliver oxygen and vital nutrients via tiny vessels, some the width of three hairs. These vessels allow one red blood cell at a time to pass, and it doesn't take much to damage that flow. 

Regular eye screening is essential, especially for those who have diabetes. The most common signs of vascular disease of the retina are blurry vision, new floaters, and loss of vision that can be partial or complete, especially if it affects just one eye and comes on suddenly, causing new headaches. Retinal vascular disorders that are linked to hypertension frequently result in headaches. If you have diabetes or high blood pressure and you are having regular headaches, please consult with your doctor and your optometrist.

 

Intermittent Claudication

This is angina of the legs.

My dad, who had cardiovascular disease, used to say, "I have to sit down; my legs feel so heavy."

It is a deep aching, pain or heaviness in the legs during exertion that eases with rest. It is caused by inadequate blood flow to the muscles. Sometimes, it is worse around the joints and can be misdiagnosed as arthritis. Intermittent Claudication is a sign of PVD and often is a warning sign for coronary artery disease. 

Testing includes checking for pulses in the feet and ankles, testing the blood pressure in the lower legs, performing an angiogram in which fluoroscopic dye is injected into the leg arteries, performing vascular ultrasound, and performing MRI and CT scans.

Interventions include increasing walking, weight loss, diabetes management, a healthier diet, quitting smoking, and medication management. Occasionally, a stent is placed in blocked arteries. 

 

Restless Leg Syndrome (RLS) and PVD

If you have Restless Leg Syndrome, ask your doctor to have you worked up for cardiovascular disease. It is thought that damage occurs to the innermost lining of blood vessels called the endothelium, and there is evidence that restless leg syndrome and peripheral vascular disease may be linked. It is theorized that both conditions cause damage to the nerves that control blood flow to the legs by inflammation and blood vessel damage from diabetes or kidney disease. 

 

Infections and Cellulitis (skin infections) of the Lower Legs and Feet

Lack of blood flow to tissues is called ischemia. Serious infections can result in sores on your feet that can usually be treated with antibiotics but may have to be treated in a hospital if the infection is serious. The infection can also spread to the tissues and muscles, to the bone, or to the bloodstream, resulting in a condition called sepsis. This is a life-threatening emergency.

Interventions include blood pressure control, diabetic control, professional foot care, and lifestyle changes, including reduction of salt, fat and processed foods, and especially restraining from nicotine and alcohol use.

 

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Healthcare education is my passion and purpose, but it does take a lot of research and time. If you, or someone you love, has benefited, your small donation will help keep this education coming.

Many thanks, Connie

Sources and Resources

 
 

Patient Pathways provides one-on-one support in helping patients access BC healthcare services and determine Advance Healthcare Directives. See our Services and Fees.

Connie Jorsvik

Connie Jorsvik is an educator, author, public speaker, independent healthcare navigator and patient advocate. Since 2011, she and her team have passionately supported hundreds of patients and families journeying through complex illness, end of life, and planning ahead.

https://patientpathways.ca/
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Hearts 101: Common Heart Diseases