Heart diseases

Coronary Vessel Disease (angina pectoris) and Cardiac Infarction

Angina pectoris refers to severe pain and a sensation of tightness in the chest, which is triggered by a circulatory disorder of the heart. The pain often spreads into the left arm (inside). This disease originates from a constriction of the coronary vessels (arteriosclerosis) caused by calcification. This leads to a lack of oxygen and nutrients in the heart, which is associated with painful episodes called angina pectoris attacks. Such an attack can particularly be triggered by physical exertion or mental stress. An attack lasts from several seconds to several minutes. An angina pectoris attack is not a cardiac infarction, but can be a first symptom to an impending cardiac infarction. In the event of more sustained pain attacks that cannot be interrupted with the prescribed drugs, a cardiac infarction must be suspected. In this case, the patient should call for medical assistance immediately.

In a cardiac infarction, circulation and oxygen supply are interrupted in a specific area of the heart due to profound blockage of a coronary artery. If the occluded vessel is not reopened within a few hours via balloon dilatation or the use of special drugs (lysis therapy), part of the cardiac muscle dies as a result of the lack of oxygen and nutrients.

Cardiac infarction is a life-threatening disease. According to the German Federal Statistics Office, the mortality rate in Germany in 2005 was 10.7% of infarction in-patients. The mortality rate is highest in the early phase. A large number of patients die before admission to hospital. Early detection in the event of corresponding pains can therefore be lifesaving.

Typical risk factors for cardiovascular constriction and cardiac infarction are:

• Smoking
• High blood pressure
• High blood fat levels
• Diabetes
• Overweight
• Stress
• Lack of exercise
  

Preventive action to avoid the progression of coronary heart disease is extremely important for all patients. This primarily includes a change in lifestyle (giving up smoking, weight reduction, physical exercise) as well as drug therapy (reduction of blood fat levels and blood pressure adjustment).

Cardiac Insufficiency (Weak Heart)

With cardiac insufficiency or weak heart, the heart is no longer able to provide the organs and tissue with sufficient blood and therefore with oxygen and nutrients. The heart is not powerful enough to meet the body's blood requirements. Cardiac insufficiency manifests itself as breathlessness, dizziness and lack of energy - first during exertion and later at rest in affected patients.

In the greater circulatory system (systemic circulatory system), the left ventricle pumps oxygen-rich blood from the lungs into the body. The right ventricle pumps the oxygen-deficient blood, which flows back from the organs, muscles and tissues, into the lungs, where it is enriched with oxygen again (pulmonary circulatory system).

With left cardiac insufficiency, the left side of the heart works inadequately and the blood congests in the lung (congested lung). Water accumulates in the lung and can cause a pulmonary edema.

With right cardiac insufficiency, the blood congests in the tissues of the body. Water accumulates in the body (e.g. in both legs, the abdominal cavity and the liver). If the pumping function of both ventricles is restricted, this is called global cardiac insufficiency.

The main causes of cardiac insufficiency are constriction of the coronary vessels including cardiac infarction, cardiac muscle diseases and inflammations, high blood pressure and valvular defects. Today, chronic cardiac insufficiency can almost be described as a widespread disease.

Metabolic disorders

Of the various other clinical pictures, heart rhythm disorders, changes to the cardiac valves and cardiac muscle diseases in particular can be attributed to inflammations or metabolism disorders.

Diagnosis

The HELIOS clinics provide the following options for heart disease diagnosis:

• Investigation of medical history (anamnesis) and physical examination
• ECG (resting ECG, exercise ECG, long-term ECG)
• Echocardiography (transthoracic ultrasound examination – through the thoracic wall, transesophageal ultrasound examination – echocardiography through the esophagus)
• Stress echo
• Cardiac catheter examination
• Electrophysiological examination (EPE)
• X-ray examination
• Long-term measurement of blood pressure
• Myocardial scintigraphy
• Nuclear magnetic resonance tomography
• Positron emission tomography (PET)
• Ultrasound (sonography)
• CT coronary angiography (cardio-CT)
• Cardio-MRT
• Sleep laboratory
• Check of pacemaker settings and queries
• Laboratory examinations (cardiac enzymes, blood fats)

Therapy

The specific HELIOS hospitals have the following options for treating heart diseases:

• Interventional therapies by means of cardiac catheter (stent implantations – introduction of vessel-supporting metal coils, Ballon angioplasty.
• Operating procedures for treating heart diseases (coronary surgery: bypass operations, operations on valvular defects)
• Lysis therapy: break-up of blood clots by means of clot-inhibiting drugs to reopen the occluded vessel
• Implantation of cardiac pacemakers and defibrillators for therapy of heart rhythm disorders
• Ablations (obliteration of electrical misdirections in the conduction system of the heart)
• Intensive therapy including artificial respiration
• Drugs