Feb 16, 2021
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Cardiac surgeon: “If the heart does not bother, it does not mean that it is healthy”

Cardiovascular diseases are one of the most common and dangerous. They are the main cause of human mortality. How to protect your cardiovascular system, and therefore life itself?

Our expert – cardiac surgeon, head of the operating department of the Center for Cardiovascular Surgery of the Main Military Clinical Hospital named after Academician N.N.Burdenko of the Ministry of Defense of the Russian Federation, Candidate of Medical Sciences Alexey Fedorov

What is not to his heart?

Elena Nechaenko, “AiF Health”: Our “motor” works without sleep and rest. How can we take care of him?

Alexey Fedorov: The heart is our inner barometer. Therefore, everything that is harmful to the body as a whole is also dangerous to it. The first is all toxic substances that get inside, for example, tobacco tar, excessive doses of alcohol, industrial emissions, and so on. The second point is nutrition. Since one of the main causes of heart disease is atherosclerosis, which is based on lipid metabolism disorders, overeating must be avoided and the consumption of foods rich in cholesterol and artificial additives must be reduced. Such food disrupts the liver, leading to fatty hepatosis. And since cholesterol is synthesized in the liver, disturbances in its work lead to hypercholesterolemia and atherosclerosis. Finally, chronic stress is very harmful for the heart – both physical, associated with lack of sleep, work for wear and tear, and psychological, caused by systematic nervous stress.

– What is more dangerous for the heart – bad heredity or an unhealthy lifestyle?

– Of course, heredity is the number one factor. Often, the heart remains healthy for a long time in people who are indifferent to healthy lifestyle, if at the same time everything is in order with their genetics. And vice versa. Therefore, if there were cases of early heart attacks in the family, it is imperative to examine the heart as early as possible.

So that the “toad” does not crush

– There are many myths about the heart. Which one, in your opinion, is the most harmful?

– I think this is a myth that if the heart does not bother, then it is healthy. This is not always the case. For example, with painless ischemia, which is most typical for people with diabetes, a person can wear plaques in the vessels of the heart that threaten a heart attack for years. However, he may not even have predisposing factors such as excess weight and physical inactivity. By the way, professional sports with high loads for the heart are also dangerous, so it is vitally important for athletes to regularly undergo a complex of examinations.

One glass a day of dry red wine, which is rich in antioxidants, has been shown to help keep your heart healthy. No wonder that in Mediterranean countries, where it is customary to drink wine at a meal, life expectancy is one of the highest in Europe. The Mediterranean diet (durum pasta, legumes, whole grain bread, fish rich in omega-3 PUFAs, olive oil, fresh herbs, vegetables and fruits) has no less influence.

– You said that coronary heart disease is often hidden. But there may be symptoms. Which one is more common?

– Angina pectoris (“angina pectoris”). It is expressed in the form of pressing or constricting pain in the chest. It can also give into the arm, the space between the shoulder blades, the jaw, or even simulate stomach pain. At the same time, it is quite simple to distinguish angina pectoris from other types of pain. This symptom occurs only after physical or emotional stress. Conventional pain relievers do not work, only nitroglycerin helps to relieve the attack.

People with new-onset angina need to do coronary angiography as early as possible (in the first days) (a study of the blood vessels of the heart, which will accurately show the presence of plaques). For people under 50 years old, MSCT coronary angiography can be an alternative. This study does not require a puncture of the vessels and the introduction of a catheter into the arteries of the heart, and at low radiation exposure it allows examining the vessels of the heart in just half an hour. But after 50 years, MSCT is no longer informative due to age-related changes in the vascular wall.

– How can a person who does not have anxiety symptoms make sure that his heart is in order?

– He needs to donate blood for a lipid profile, do an ECG and ultrasound of the heart (echocardiography). These are key studies to help rule out heart problems.

– Do you have to take statins for life with high cholesterol?

– By itself, high cholesterol is not an indication for drug therapy, since for the development of atherosclerosis, in addition to this, problems with the inner wall of the vessel (intima), ready to take this cholesterol, are needed. After all, if the vessels are strong and healthy, even high cholesterol is not terrible for them. And they weaken the vascular wall most often diseases in which chronic inflammation occurs (for example, diabetes mellitus and arterial hypertension, which acts on the vessels as corrosion to metal).

If cholesterol is elevated, it is necessary to assess the state of blood vessels. The main method for this is USDG of the carotid arteries. If the vascular wall is changed or there are plaques covering the vessel lumen by 10-15%, then atherosclerosis is already developing. You can also do a stress test (the ECG is taken not at rest, but while walking on a treadmill or riding an exercise bike) to see if there is myocardial ischemia. And only after the examination can therapy be planned. Starting treatment with statins early is just as bad as being late. They must be taken on time and according to indications.

– What should people who have suffered a heart attack do so that the catastrophe does not happen again?

– First, undergo coronary angiography, if it has not been performed before. This will help you find out how things are not in one affected heart vessel, but in all the others. Based on the results of the study, it will be clear what to do next: continue to be treated conservatively or perform an operation (vascular stenting for small lesions and coronary artery bypass grafting, if there are many plaques). But without fail, all patients after a heart attack should regularly take antiplatelet agents that thin the blood, and in some cases, anticoagulants and other drugs. By the way, it is known that those cores who took drugs to prevent blood clots before the disease were able to tolerate COVID-19 more easily. After all, these same drugs are now basic in the treatment of coronavirus infection.

There are contraindications. Be sure to consult your doctor

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