Heartaches are scary. After all, as is well known, such complaints can indicate serious cardiovascular diseases. Therefore, medical help should always be sought. But sometimes the cause of the pain in the chest area remains unclear for a long time.
On World Heart Day, the German Heart Foundation draws attention to vascular diseases of the heart and how to protect yourself from them. In addition to coronary heart disease (CHD) as the main cause of heart attacks, diseases of the small heart vessels (microvessels) are also increasingly becoming the focus of cardiac medicine.
Know personal health values
As experts explain, heart diseases caused by reduced blood supply and the resulting lack of oxygen and nutrients are by far the most common heart disease.
The heart attack is the most fatal phenomenon with all its serious consequences such as heart failure (heart failure) or sudden cardiac death.
However, this event is often preceded, unnoticed, by coronary heart disease (CHD) for decades. Typically, deposits of cholesterol, calcium, inflammatory cells and connective tissue increasingly narrow the blood vessels, especially the coronary arteries in the heart muscle (arteriosclerosis/”hardening of the arteries”).
“It is therefore particularly important that everyone should know their personal health values such as LDL cholesterol, blood sugar and blood pressure in order to reduce their individual risk of heart attack,” advises Prof. Dr. med. Thomas Voigtländer, CEO of Deutsche. Heart Foundation.
“It is equally important to know well the signs of coronary artery disease, which can become apparent long before the heart attack under physical stress with symptoms such as shortness of breath, chest tightness and chest pain,” explains the cardiologist on the occasion of World Heart Day under the motto “Sagittarius Your vessels!”.
Every minute counts
“Anyone who suffers a heart attack can only protect their heart from irreparable damage and complications, including death, if he or she immediately alerts the emergency services by calling 112 if a heart attack is suspected,” warns Voigtländer, medical director of the Agaplesion Bethanien Hospital in Frankfurt am Main.
When it comes to a heart attack, every minute counts because the heart attack can at any time turn into malignant cardiac arrhythmias such as ventricular fibrillation, which lead to cardiac arrest and death after just a few minutes.
Heart attacks often occur at home. It is therefore important to start resuscitation right there if you are unconscious and not breathing.
The rescue team called via the emergency number 112 can then use a defibrillator to restore the fibrillating heart to its normal rhythm and then immediately take the patient to the nearest clinic for heart attack care.
Constrictions in the very small heart vessels
According to estimates by experts, 50 percent of patients with suspected CHD and angina pectoris symptoms (chest pain) who receive a cardiac catheter examination do not have the typical narrowing of the coronary arteries, but rather other causes.
The focus is increasingly on narrowing of the very small heart vessels, which, due to malfunction, lead to heart pain and significantly reduced resilience in the patient.
Such a so-called coronary microvascular dysfunction (CMD) or microvascular angina is characterized by limited extensibility or an increased tendency to spasm (coronary spasm) of the small and smallest heart vessels.
“Those affected with symptoms of microvascular angina such as chest pain, chest tightness and shortness of breath even with minimal physical exertion are subject to a high level of suffering. Due to the lack of findings in the large coronary arteries, a psychological explanation is often resorted to,” explains Prof. Voigtländer.
“It is therefore particularly important to carry out further diagnostics so that the actual cause – namely a possible malfunction of the small and smallest coronary arteries – can be found.” This is the only way to find the right therapy quickly.
“As with CHD, diseases of the microvessels of the heart are based on risks such as high blood pressure, high LDL cholesterol, diabetes or genetic factors that require appropriate treatment with medication and lifestyle changes,” explains the cardiologist.
Women are more often affected by microvascular angina than men due to hormonal differences and the different heart anatomy (on average, smaller heart, smaller vessels).
It often takes a long time before a diagnosis is made
Until microvascular angina is diagnosed with the help of imaging procedures such as cardiac ultrasound, MRI or positron emission tomography/PET, those affected often have an odyssey through a large number of (specialist) doctor’s offices.
The level of suffering is correspondingly high, as everyday life is limited due to the recurring symptoms of shortness of breath and chest pain.
Experts are calling for a “holistic view of cardiac blood flow.” Because these small and smallest, finely branched blood vessels in the heart muscle regulate around 80 to 90 percent of the blood flow and are therefore the heart’s main supply of oxygen and nutrients.
But the main focus – even in diagnostics – is on the large heart vessels, which, like large pipes, only deliver the blood to the actual distribution point.
“Especially in patients who have been complaining of persistent chest complaints for two to three years but no diagnosis has been made, one should definitely consider microvascular angina and use the available modern examination procedures,” emphasizes Prof. Dr. med. Peter Ong, senior physician in the Department of Cardiology and Angiology at the Robert Bosch Hospital Stuttgart.
According to Prof. Ong, according to current studies, the risk of serious events such as death, heart attack and stroke caused by microvascular angina is lower than in patients who have CHD with stenosis (narrowing) of the large heart vessels. Nevertheless, there is a risk of such events that should not be underestimated.
Drug therapy reduces this risk and, above all, significantly improves the quality of life. Drug treatment for high blood pressure, diabetes and high LDL cholesterol often alleviates the symptoms.
Depending on the cause of the microvascular angina, other medications may also be suitable for those affected: Patients with coronary spasms, for example, often benefit from calcium antagonists and nitrate preparations, and in the case of acute symptoms, especially from a nitro spray.
Those affected with a limited ability to expand their vessels often benefit from beta blockers. “Once these patients have been diagnosed, we can effectively help them with medication and help improve their resilience in everyday life and their prognosis,” says cardiologist Prof. Ong. (ad)