Heart Day is celebrated all over the world on September 29. This holiday is dedicated not at all to love and romance, but to the health and prevention of diseases of one of the main organs of the human body. For many years, diseases of the cardiovascular system have been the leading cause of death in the world. More than 17,500,000 people die from diseases of the circulatory system worldwide every year. But most of them could have been prevented with timely prevention and proper treatment.
World Heart Day is meant to remind people of how important it is to monitor the health of this organ. Russia actively supported the international initiative; every year our country hosts many thematic events. This year a round table under the motto “Heart for Life” was held at the Euroonco clinic in Moscow. The event was attended by cardiologists and oncologists of the leading medical centers of the capital: cardiologist “Euroonco”, Ph.D. Olga Kozlova, leading cardiologist “CM-Clinic” Olga Cherenkova, cardiologist of the Clinical Hospital of the Administrative Department of the President of the Russian Federation Evgeniya Pluzhnikova, arrhythmologist “Euroonco”, Ph.D. Roman Ovchinnikov other. In addition to traditional topics, experts discussed such a relatively new direction in medicine as cardio-oncology.
Cardio-oncology guards the long life of cancer patients
As the cardiologist told Euroonco Olga Kozlova, today, thanks to the improvement of treatment methods, the life expectancy of cancer patients has increased. But often, against the background of anticancer therapy, due to its cardiotoxicity, patients develop cardiac complications. In such cases, the cause of death may not be a malignant tumor, but concomitant heart disease. Cardio-oncology is intended to prevent this.
– Cardiotoxicity occurs in the course of radiation and chemotherapy, – Olga Kozlova explained. – However, cardiac complications also occur during surgery. There are drugs with more pronounced cardiotoxicity, such as anthracyclines, related to chemotherapy. Targeted and immunotherapy drugs are less cardiotoxic and easier to tolerate by patients, but they also have their own characteristics. The most frequent cardiovascular complications in cancer patients can be: the development of arterial hypertension, coronary heart disease, cardiac arrhythmias of varying degrees, thromboembolic complications, and others. The help of a cardiologist is needed to prevent their development and to prescribe treatment in a timely manner without interrupting anticancer therapy.
According to the Euroonco cardiologist, it is very important to conduct a thorough examination before starting cancer treatment in order to exclude or minimize the risks of cardiac complications. For diagnostics, screenings are used, including ECG registration, examinations, measurement of blood pressure and pulse, echocardiographic examination of the heart to determine the so-called ejection fraction – the force with which the heart contracts. If problems are identified that require in-depth study, Holter ECG monitoring, daily monitoring of blood pressure are prescribed.
– We carry out a very strict control of hemodynamic parameters, which are obtained using ultrasound. Also, computed and magnetic resonance imaging, scintigraphy are performed to assess the blood supply to the myocardium. Exercise tests are sometimes done to detect coronary heart disease in patients, although they have limitations in cancer patients. Due to the close cooperation of oncologists and cardiologists, we reach a consensus on the selection of treatment taking into account the patient’s status and prescribe the safest chemotherapy, minimizing the risks associated with cardiotoxicity, says Olga Kozlova.
The cardiologist emphasized that arterial hypertension, impaired carbohydrate and lipid metabolism, high blood pressure are factors contributing to the development of cardiotoxicity. Problems often arise when deciding on surgery. If cardiac abnormalities are detected, special therapy is prescribed, and only when the patient is ready, antitumor treatment or surgery can be prescribed. But in the future, the cardiologist continues to guide the patient.
Heart Diseases “Get Younger”
Even without taking into account cancer, a person can face many heart problems if they do not take proper care of their health. As the leading cardiologist of the “CM-clinic” told Olga Cherenkova, today diseases of the cardiovascular system are “getting younger”: in her practice there was a case of a heart attack in a twenty-seven-year-old man. It was the heart attack that the doctor called one of the most dangerous complications of cardiopathologies.
– Myocardial infarction is associated with rupture of an atherosclerotic plaque, which is located in the coronary vessels. Thus, the lumen for the blood flow is blocked, as a result of which the heart muscle tissue dies, – says Olga Cherenkova. – The most common cardiovascular disease is arterial hypertension. Nowadays there are a huge number of antihypertensive drugs, but, unfortunately, many do not follow the blood pressure figures and come with severe hypertensive pathologies and complications in the form of left ventricular myocardial hypertrophy, complications in the fundus, problems with blood vessels and kidneys, rapid development atherosclerosis.
According to the cardiologist, heart failure occurs as a complication of many heart diseases and occurs as a result, for example, of myocardial infarction or myocarditis, which a person might not have noticed. A viral infection can give heart complications, but not all patients understand this, so they turn to a specialist too late.
Dyslipidemias – lipid metabolism disorders – are also an important problem. This disease occurs in 70% of the population, and more often in men. Women are protected from this disease, but as soon as they enter menopause, the risks are almost equalized. It is impossible to modify these risks – these are male gender, genetics and age.
– It is important to monitor blood cholesterol levels, conduct diagnostic cardiac screenings, which include ultrasound examination of the heart and brachiocephalic arteries, 24-hour blood pressure monitoring to detect nocturnal hypertension that can lead to stroke, and other tests. Of course, it is necessary to monitor the level of glucose in the blood, – Olga Cherenkova shared.
The doctor advises to pay attention to your well-being and, if pressing, compressive chest pain appears, which radiates to the left hand, sometimes to the lower jaw, between the shoulder blades, immediately consult a doctor. After all, a heart attack can happen out of the blue in a seemingly healthy person. Risk factors can be stress, insomnia, emotional distress. Therefore, practicing cardiologists advise to be examined regularly in order to minimize the risks of such serious illnesses that change life to “before” and “after”.
Arrhythmia can be eliminated once and for all
In some cases, the cardiologist requires the help of a specialist arrhythmologist. Arrhythmology is a type of cardiovascular surgery. We can say that this is a cardiac electrician and work with disturbances in rhythm and conduction. There are tachyarrhythmias with a high heart rate and bradyarrhythmias with a low rate, and both problems are treated by arrhythmologists.
As the arrhythmologist told Euroonco Roman Ovchinnikov, the help of an arrhythmologist is needed when the patient’s cardiological resource is exhausted, there are restrictions on the appointment of certain drugs, or when the problem is successfully eliminated by surgery. For example, some types of tachyarrhythmias should not be treated with pills if minimally invasive surgery can be performed that completely relieves the patient of long-term drug use and associated side effects. It is necessary to offer surgical treatment for this problem. True, not all types of arrhythmias need to be treated surgically.
– There are age, physiological, individual norms, so each patient needs to be dealt with separately, – says the doctor. – Not all arrhythmias need to be treated. It happens, for example, that with an increase in body temperature, the heart rate rises, but this is quite physiological and compensatory. A high heart rate may be due to low hemoglobin. If the quality of the blood is improved, the heart rate will also be normalized. Therefore, it is imperative to carry out in-depth diagnostics and identify the essence of the problem.
But there are also life-threatening arrhythmias, the occurrence of which should not be allowed and which must be corrected with treatment. If the patient can carry out daily activities, move without dizziness, hypotension and severe weakness, this is a planned situation that requires planned assistance. If the arrhythmia provoked vascular collapse, a sharp decrease in pressure, problems up to loss of consciousness and fainting, this is an urgent situation when it is necessary to call an ambulance team and make a decision: to treat on the spot or be hospitalized.
Arrhythmias are a particular problem for cancer patients. Sometimes they are associated with reversible situations – electrolyte disturbances, water imbalance, intoxication, combination with viral load. Then arrhythmologists intervene in the situation and offer the patient treatment for the cause of heart rhythm problems, for example, restore potassium levels, carry out detoxification, and so on.
Better to prevent than to cure
Of course, any disease is better prevented than cured. As the cardiologist told Evgeniya Pluzhnikova, in the case of the heart, a healthy lifestyle is more important than ever. If you adhere to a few rules, the risks of heart disease can be minimized.
“Firstly, adequate physical activity is useful at any age,” explains the cardiologist. – The heart needs aerobic exercise – walking, jogging, swimming, cycling, fitness. The patient can choose those exercises that he likes, but various general physical activities must necessarily be in everyday life. Secondly, a healthy diet. This is especially important for patients with dyslipidemia, threatened coronary heart disease, or an already confirmed diagnosis. Such patients need to adhere to a Mediterranean diet — eat more fruits, vegetables, fish and cereals. Animal fats should be limited by excluding meat and eggs from the daily menu.
Patients with hypertension and heart failure should definitely limit their salt intake so that the body does not accumulate fluid, because sodium increases the osmotic pressure of the blood, and the feeling of thirst increases. There is good news for coffee lovers: this drink can be consumed in small quantities if the patient tolerates it well, that is, if coffee does not cause him to increase blood pressure, tachycardia. In this case, a cup of weak coffee in the morning is quite acceptable.