Cape Town:  021 201 1119  

Arterial Cardiovascular Disease

Cardiovascular disease is one the leading causes of death worldwide. Although aspects of Cardiovascular disease are being managed, is it really being treated as it should and managed holistically in this fast paced society today? Find out the facts, understand the current condition of your body and you decide what is best for you. You owe that to yourself. 

What is cardiovascular disease?

CardioIn order to survive, our bodies need oxygen and nutrients delivered to all the many cells of our body (approximately 3.72X1013 cells). The cells need to not only survive but also function effectively.  All the arteries in our body (red vessels in the picture above) take blood with oxygen and nutrients and deliver them to these cells. Arteries travel away from the heart and the blood within moves from the pumping action of the heart. 

Veins (the blue vessels) are a different structure and they return blood to the heart after oxygen and nutrients have been delivered to the cells. The blood then obtains more oxygen from the blood and the heart pumps this oxygenised blood out through the arteries again and the cycle continues. Arterial (artery) and venous (vein) disease are very different in terms of risk factors, symptoms and outcomes.

 

 

How do the arteries become narrowed?

arterial2The most common way in which the arteries become narrowed is from the development of atherosclerosis or plaque. There are many theories as to the development of the plaque but the exact theory is not known. We do, however, know that certain risk factors promote the progression of this disease. Some cannot be changed such as age and gender but there are the major risk factors that can be addressed:

  • Diabetes
  • High Blood Pressure
  • High cholesterol
  • Smoking
  • Increased Body Mass Index (weight) (BMI)
  • Exercise

These are all indicators of a ‘westernised’ lifestyle with our change in eating habits and becoming more sedentary. As this happens, these risk factors all worsen as they are affected by diet as well as other factors. As the plaque develops in more arteries and becomes larger, there is less blood flow to organs and the arteries become narrowed.

When there is a narrowing in the arteries the amount of blood and nutrients that can be delivered is diminished. Depending on which artery is affected, the suffering cells and organs function poorly and eventually some of the tissue in the organ may die.

Symptoms of decreased oxygen and nutrients (decreased perfusion) before tissue death.

Organ the arteries deliver to

Decreased perfusion before tissue death Decreased perfusion after tissue death
Heart
(Coronary Arteries)
Chest pain
(Angina)
Heart attack
(Myocardial Infarction)
Brain
(Carotid Arteries)
Minor, reversible stroke
(Transient ischaemic Attack; TIA)
Major stroke
(Cerebrovascular accident; CVA)
Legs
(Iliac, femoral, popliteal, tibial, peroneal arteries)
Pain when walking, Pain when resting
(Claudication)
Ulceration, gangrene
(Non-healing ulcer, Tissue necrosis)
Kidneys
(Renal Arteries)
High blood pressure
(Hypertension)
Kidney dysfunction
(Renal failure)

All the above diseases are typically a spectrum of one disease – atherosclerosis. This is what causes the narrowing of the arteries. Cardiac surgeons see patients with heart problems and narrowing of these arteries.  Vascular surgeons see patients with the other arteries affected.

When there is disease in the legs, it is an indicator of advanced atherosclerosis throughout the body and all arteries may be affected to some degree. In fact, 65 % of patients with disease in the legs have disease in other parts of the body. Importantly, disease in the legs may not initially give symptoms – especially if you are inactive. More importantly, lower limb arterial disease is a very severe risk indicator and should not be ignored. In fact, the mortality or death rate is higher for severe or critical limb arterial disease than for 4 of the top 5 cancers – breast, colon, bladder and prostate. (Should a vascular surgeon need to do a bypass on a leg the mortality (or death) rate is 20% in one year.)

Very important: Patients do not usually die from a leg problem,  but rather from the atherosclerosis causing a heart attack or a stroke. So the important lesson is that everyone needs their own additional individual risk factor management – according to your disease burden, your risk factors and your lifestyle.

The ultimate goal is to prevent people from developing leg problems, strokes and heart attacks - or at least decrease the severity of them. There is no cure. Risk factors can only be controlled. Every case is different. Every patient needs their own individual management.

Who would benefit from assessment and an individualised programme?

  • Anyone with leg symptoms
  • Anyone younger than 50 years with a history of smoking or diabetes
  • Anyone older than 70 years old
  • Anyone with multiple cardiovascular risk factors (smoking, diabetes, high blood pressure, high cholesterol/lipids)

Contacts

Room 1521 Christiaan Barnard Hospital, Cape Town, 8001.

  Cape Town Switchboard:  021 201 1119