Brain aneurysm

Brain aneurysm

A brain aneurysm is an abnormal enlargement of a blood vessel in the brain. Arteries that supply the brain are branched out from the set of arteries that is located at the base of the brain. Those branching sites are the most common locations where brain aneurysms occur. Brain aneurysms can affect anyone, including children, but the are more commonly seen in adults 35 to 60-year-old, slightly more common in women.

How does it happen?

The wall of the artery becomes weaker in some places over time and due to long-lasting pressure, an enlargement (bulge) occur. That bulge may be in the form of a sac (balloon-like) and then it is called a saccular aneurysm, which represents the most common form of this condition. The other form of brain aneurysm represents a spindle and then it‘s called a fusiform aneurysm.

As the enlargement grows, the sack expands and creates a neck that makes a connection to the artery. When the brain aneurysm is small it doesn‘t pose a greater danger, but as it grows larger it gets prone to a rupture which causes the leakage of blood into the area between the brain and the lining that separates it from the skull, called subarachnoid hemorrhage.

Signs and symptoms

In some cases, people with an aneurysm do not have any symptoms at all. Because the growth of the aneurysm can pressure the surrounding tissue, symptoms such as headache, diplopia (double images), lower eyelid, pain behind or above the eye, trigeminal neuralgia, or uneven pupils may occur.

Symptoms of aneurysm rupture: sudden, extremely (as never before) severe headache, nausea, vomiting, neck stiffness, changes in consciousness to coma.

Massive intraventricular hemorrhage usually gives a very difficult clinical picture: deep coma, hyperpyrexia, decerebrate rigidity. It almost always ends in death.

brain

Brain aneurysm rupture

The rupture of brain aneurysms involves the breaking of blood vessels in the brain. This leads to hemorrhage in the area of the brain membranes, sometimes leading to hematoma or penetration of blood into the ventricular system. All of this together causes brain damage. In 40 percent of cases of a brain aneurysm that suddenly cracks can be the cause of death, and if the patient survives, each new rupture in the next 15 days increases the mortality rate by up to 70 percent.

Risk factors for brain aneurysm rupture

The most common risk factors for brain aneurysm rupture are hypertension, smoking, patient age (ruptures are more common after 40 years), atherosclerosis, use of medications such as aspirin or anticoagulant therapy, cocaine use, alcohol consumption, head injury, and low doses of estrogen after menopause. Brain aneurysms are more common in women after menopause. A family history of aneurysms is another risk. It should also be noted that certain diseases, such as polycystic disease and AV brain malformations, formerly associated with aneurysms.

Brain aneurysm rupture vs stroke

The concepts of brain aneurysm rupture and stroke should be separated. In the case of a rupture, bleeding occurs in the brain, which gives a clinical picture of a sudden headache, unlike a stroke, where the clinical picture is followed by a sudden resulting half-body paralysis and loss of speech. However, after a rupture, there may be a stroke as a result of the blood vessel spasm. The classic cause of brain infarction is the closure of a blood vessel by a thrombus, most often scattered from the heart during arrhythmia, or stenosis of the blood vessels of the neck and brain.

brain aneurysm

Treatment

In cases of aneurysm rupture or significant enlargement, treatment is always surgical. Before surgery, it is necessary to determine the condition of the cardiovascular system of the patient, since atherosclerosis is also present in a large number of patients.

Whether it is an aneurysm rupture or not, therapy is surgical, in the domain of a neurosurgery specialist.

Surgical clipping on the neck of the aneurysm involves a neurosurgical procedure in which a thin metal clip is placed in a place of the neck of the aneurysm, which presses the neck of the sacral aneurysm and prevents blood supply to it.

Endovascular coiling is a procedure similar to angiography when an aneurysm catheter is placed and a small metal coil or balloon is placed in it to stop the blood flow to the aneurysm.

In cases where a person is found to have a small, asymptomatic aneurysm, depending on the size, location, growth of the aneurysm, and on the age of the patient, it depends on whether one of these methods is immediately followed, or whether the patient will be monitored.

Chronic kidney disease

Chronic kidney disease

Chronic kidney disease (chronic kidney insufficiency / chronic renal failure) is a disorder in which kidneys are losing their function gradually over time. That process usually takes months or years. It can not be reversed, but with early diagnosis, appropriate treatment and some changes in lifestyle, it can slow down or in some cases even stop.

Epidemiology

This disease represents a huge health problem and it is often associated with cardiovascular diseases. Millions of people die every year due to this problem, and around 10% percent of the human population is affected by it. People with hypertension or diabetes have a greater chance of developing chronic kidney disease. Chronic kidney disease is also a major financial problem, as many people can’t afford to treat it effectively.

Classification of chronic kidney disease

Chronic kidney disease can be classified due to the severity of condition on 5 stages, from very mild stage 1 to end-stage 5.

Glomerular filtration is the ability of kidneys to filtrate waste products and excess fluids into urine collecting tubules allowing their elimination. Stages of renal failure are divided by the glomerular filtration rate.

Stage 1 – There is mild kidney damage with normal glomerular filtration rate ≥ 90 ml / min / 1.73 m2

Stage 2 – There is mild kidney damage with lowered glomerular filtration rate between 60 and 90 0 ml / min / 1.73 m2

Stage 3 – There is a moderate kidney damage with glomerular filtration rate between 30 and 60 ml / min / 1.73 m2

Stage 4 – There is moderate or severe kidney damage with glomerular filtration rate between 15 and 30 ml / min / 1.73 m2

Stage 5 – There is severe kidney damage where they are about to or at complete failure with glomerular filtration < 15 ml / min / 1.73 m2

chronic kidney disease

Signs and symptoms

Signs and symptoms of chronic kidney disease often nonspecific showing up only after kidney suffer irreversible damage. One of the most characteristic signs of chronic kidney disease is swelling around eyes, ankles or other body parts due to the inability of kidneys to remove excess water or because of increased protein loss. Also, changes in urination may occur. As most of the signs and symptoms are nonspecific they include various organs and systems of organs, and some of them are:

Cardiovascular disorders which include hypertension, heart failure, arrhythmia, and pericarditis.

Manifestations of the central nervous system which include fatigue, sleepiness, hallucinations, loss of concentration, different consciousness problems including coma. While peripheral nervous system manifestations show up as muscle pain, cramps, tingling, or restless leg syndrome.

Hematological disorders like anemia, bleeding or infections.

Metabolic disorders including acidosis, electrolyte imbalance, and azotemia.

Gastrointestinal disorders, including loss of appetite, nausea, vomiting, burping, diarrhea, or esophagitis.

Treatment

The goal of chronic kidney disease treatment is to slow down or stop the disease progression. Treatment of the cause of kidney disease and hypertension is needed in a state of decreased kidney function. When the levels of nitrogen-containing compounds such as urea and creatinine get increased causing condition known as azotemia, it is needed to limit the intake of proteins, salt, and potassium, while also limiting physical activity. Acidosis is treated with bicarbonate, and anemia with iron.

When chronic kidney disease progresses into end stage, dialysis or kidney transplantation is needed.

Hypertension in pregnancy

Epidemiology of hypertension in pregnancy

Hypertension in pregnancy is the most common health disorder found in pregnant women, present in approximately 10% of this population. Nearly 8 – 13% of pregnant women in the United States are affected by this condition, and the prevalence is increasing in developing countries. Hypertension in pregnancy represents a major problem as it is one of the 3 main causes of death in pregnant women. About 50% of pregnant women with this condition develop hypertension in late pregnancy, especially last month.

Classification

Hypertensive disorders during pregnancy are divided into 4 categories including chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension, and gestational hypertension.

Chronic hypertension

Chronic hypertension is a blood pressure of 140 / 90 mm Hg or above for both systolic or diastolic, or one of those values separately, present before pregnancy or manifested before the 20th week of pregnancy. It is lasting more than 12 weeks after giving birth.

Preeclampsia and eclampsia

Preeclapmsia is a syndrome that occurs in pregnancy which is besides hypertension, characterized by increased concentration of proteins in urine (proteinuria). These disorders may affect the development and growth of the fetus. Some signs and symptoms of preeclampsia include swelling (edemas) which may cause upper abdominal pain if they occur in the liver; severe headaches, and visual disturbances.

Eclampsia represents the complication of preeclampsia, where a pregnant woman with preeclampsia develops epileptic-like seizures, caused by cerebral edemas.

hypertension in pregnancy

Preeclampsia superimposed on chronic hypertension

This condition occurs in pregnant women who were previously diagnosed with hypertension and it’s characterized by worsening of hypertension after the 20th week of pregnancy accompanied by proteinuria.

Gestational hypertension

Gestational hypertension is a type of hypertension that occurs in pregnant women after the 20th week of pregnancy in women who didn’t have hypertension before. This condition often draws back after 12 weeks after the delivery. Gestational hypertension isn’t accompanied by proteinuria.

Treatment of hypertension in pregnancy

Treatment of hypertension in pregnancy includes non-pharmacological measures and antihypertensive drugs. Women who are previously diagnosed with mild to medium hypertension usually continue to receive their therapy, if the drug isn’t contraindicated in pregnancy in which case it should be replaced with another one.

Non-pharmacological measures

Non-pharmacological measures are recommended to all women with hypertension. Women need to check their general condition and blood pressure regularly, resting frequently. It is advised to sleep in a left lateral position (left side). It is not advised to restrict the intake of calories and sodium, as sodium intake restriction can decrease the volume of intravascular fluid, and diet restriction may affect fetal growth, which isn’t desirable.

hypertension in pregnancy

Pharmacological measures

Treatment of hypertension in pregnancy with drugs are needed in women with blood pressure ≥ 140 / 90 mm Hg and with gestational hypertension, preeclampsia superimposed on chronic hypertension or with subclinical organ damage. In other conditions, treatment with drugs is recommended if blood pressure is ≥ 150 / 95 mm Hg.

Drugs which are mostly used in these conditions are methyldopa, labetalol, and niphedipine.

Methyldopa

Methyldopa is proven to be effective and safe in pregnancy by numerous clinical trials. It works on the central nervous system, as it is metabolically changed into α-methylnorepinephrine which activate α2 receptors decreasing blood pressure.

Labetalol

Lebetalol is both alpha and beta blocker. It decreases the blood pressure by inhibiting the β1 receptors in the heart, and α1 receptors within the vascular smooth muscle. It is effective in hypertension in pregnancy.

Niphedipine

Niphedipine is a calcium channel blocker. It blocks the L-type calcium channels in arteries causing vasodilation, decreasing the blood pressure.

Sleep apnea

What is sleep apnea

Sleep apnea is a sleep disorder that is manifested with short-term interruption of external breathing with preservation of internal breathing, or a pause in breathing that lasts between 3 and 10 seconds. Insufficient attention is given to this disease although it’s not such a rare disorder, as it is estimated that about 5% of the world’s adult population (especially men) suffer from this condition.

How does sleep apnea look like

This problem is mostly recognized by a partner of the affected person, and it is distinguished by loud and heavy snoring. Sleep apnea may be recognized when the other person isn’t present, and common symptoms include chronic fatigue, headache, lack of attention and concentration, sleepiness, etc.

Sleep apnea manifests during the night in the form of respiratory failure and “fight” for the air. The sight of an endangered person may look quite dramatic for someone who watches it, even though the patient is not aware of the apnea. However, advanced apnea can affect people who suffer from this disorder and have a feeling of choking, and can also cause many other health complications.

sleep apnea

Risk factors for sleep apnea

Everything that increases the chance of developing sleep apnea symptoms in a person, can be identified as risk factors. The most common risk factors for the occurrence of sleep apnea are:

anatomical anomalies – people with a narrowed diameter of upper airways are more likely to have sleep apnea

body weight – obese people have about 6 times more chance of developing apnea than people who maintain normal body weight

sex the reason is not known, but the fact is that the risk of developing apnea is almost twice as high in men than in women

age – older people are more likely to develop sleep apnea as it most commonly occurs in people older than 60 years of age

nasal congestion – sleep apnea is about 2 times more likely to occur in people who have nasal deviations or congestion during sleep

snoring – people who have a problem with snoring in their sleep are more prone to experience sleep apnea

smoking – smokers have 3 times more chances of suffering from this disease

Diagnosis of sleep apnea

Nocturnal polysomnography is the gold standard for diagnosing sleep apnea and respiratory disorders during the sleep in general. Polygraphic factors are those who are monitored during sleep including respiration, thoracic and abdominal movements using elastic belts with sensors, while also monitoring heart, eye, lung, and brain activity, and oxygen saturation in the blood. Other home sleep tests exist, where breathing, heart rate, airflow and oxygen level in blood are monitored.

Treatment

For mild cases of apnea, a doctor may only recommend a lifestyle change such as weight loss, alcohol avoiding, quit smoking, regular sleeping, and sleeping on the side.

Certain devices can help in opening of the blocked respiratory tract. In other cases, surgical treatment may be required.

CPAP sleep apnea

In severe cases of obstructive apnea, an airway pressure device is used. Most commonly device of this type is CPAP (Continuous positive airway pressure). It consists of a small turbine that creates a positive air pressure that flows through the mask on the face of the patient. In this way, the breathing path is maintained continuously open. It’s a sophisticated device that works almost silently and is comfortable for patients.

Surgery is usually an option only after other treatments have failed. It involves the reconstruction of the upper respiratory tract, with the aim of increasing the passability through the airway and removing the cause of snoring. One of the solutions is also the tracheotomy or the opening of the trachea.

Effects on cardiovascular system

People with sleep apnea have a 50% higher risk of arterial hypertension, 25% higher risk for atrial fibrillation, and a 60% higher chance of stroke occurrence. During the stopping of breathing, the supply of blood with oxygen is reduced. This results in the development of oxidative stress, dysfunction of the endothelium of the blood vessels, and inflammation. Consequences of those occurrences lead to the development of blood vessel diseases and the processes of atherosclerosis, platelet activation, as well as the ischemia of the heart muscle.

The link between hypertension and insomnia

The link between hypertension and insomnia was questioned for a long time, as those two conditions are co-related, but first, we need to see what insomnia really is.

Insomnia

Insomnia is the most common sleep disorder. It involves difficulty in sleep initiation, difficulty in maintaining the sleeping state or falling asleep after an early wake-up. Insomnia can be temporary or chronic. Almost everyone has occasional nightmares, perhaps due to stress, heartburn or drinking too much coffee or alcohol. But insomnia is a lack of sleep that can occur regularly or repeat itself, often without an obvious cause.

How much sleep is enough depends from person to person. Although 7 hours of sleep is some average, to some people is 4 or 5 hours of sleep enough, while others need 9 or 10 hours of night sleep.

Types

Transient insomnia is a type of insomnia that is lasting from one to several nights within a single episode. It is usually a result of stress.

Acute insomnia lasts from a few days to three weeks. It is usually caused by stress induced by recovery from surgery, short-term illness, the death of a close person, the beginning of work at a new or more responsible workplace.

Chronic insomnia lasts for months or years, and it is usually a reflection of psychiatric, or long-term health disorders, the use of some drugs, or basic sleep disorders. Long lasting insomnia can be permanent or with changes in insomnia and regular sleeping.

the link between hypertension and insomnia

The link between hypertension and insomnia

Lack of sleep affects the elevation of blood pressure, which in time can cause damage to the heart muscle, arteries, kidneys; it can weaken the vision and induce many other diseases.

In one clinical study volunteers stayed awake for 88 hours and after that their blood pressure was much higher than usual. Moreover, blood pressure was also elevated in the group of participants who slept for 4 hours during the night, compared to those who slept for 8 hours. The concentration of C-reactive protein, which is a marker for heart disease, was increased in those who were completely or partially deprived of sleep. High blood pressure or hypertension often shows no symptoms. However, if high pressure is not placed under control, it can cause a heart attack or a stroke.

Increase in blood pressure due to stress can be dramatic, but when stress is stopped, the pressure returns to normal. But, if stressful situations are repeated and pressure often elevates; blood vessels, heart, and kidneys can be damaged as if the pressure was constantly increased. If you are smoking, drinking or eating as a reaction to stress, that behavior contributes to increased blood pressure.

Many health problems are associated with a lack of sleep, but the very important fact is that people who sleep less than seven, eight hours a night for a long time have a significantly higher risk of sudden death.

Sleeping position

If you suffer from high blood pressure, you must follow the treatment prescribed by your doctor, control your diet, and regularly measure your blood pressure. However, medical research has proven that sleeping on the stomach, facing the cushion, helps in lowering blood pressure.

Effects of hyperthyroidism on cardiac function

Diseases of the thyroid gland can directly modify the normal function of the heart, cause symptoms and lead to serious complications. To understand how they affect the heart, it is important to first understand how the heart works.

The heart is a muscle made of cavities whose walls contract and circulate the blood all over the body. Because of the valves inside the heart, blood flows ordinarily only in one direction. The oxygen-poor blood returns to the heart by the veins, the inferior and superior vena cava into the right atrium and the right ventricle of the heart pump the blood into the lungs. From there, the oxygen-rich blood returns to the left atrium within pulmonary vein and the left ventricle from which it is ejected into the arteries which distribute the blood to the various organs of the body.

hyperthyroidism

With regard to thyroid diseases, it is important to understand two principles. First, because the heart itself is a muscle, it needs oxygen to function and receives oxygen through special arteries called coronary arteries. If these coronary arteries have a disease that causes an obstruction in the lumen of the vessel (atherosclerosis), resulting in reduced blood flow to the coronary artery, the heart muscle then functions with insufficient oxygen supply and that can cause heart pain, or “angina pectoris”. Second, in order for the heart to beat in a coordinated fashion and expel blood evenly and efficiently, the heart muscle is stimulated to contract in a synchronized manner by specialized tissue inside the heart that emits electrical impulses.  The impulse normally starts from the top of the right atrium and descends as it spreads through the heart.

Symptoms and signs of hyperthyroidism

hyperthyroidism

An increase in the level of thyroxine (T4) secreted by the thyroid gland stimulates the heart, which then beats faster and stronger. Almost all of the T4 (and T3) found in the blood is bound to protein, but only free T4 and T3 can bind to receptors. At first, higher levels of FT4 and FT3 can cause a rapid heartbeat, called tachycardia. A nurse or doctor will detect this condition, but usually the patient will not even notice it. However, if the accelerated heart rate get worse, the patient may feel palpitations, which means that he will be aware of the heartbeat in his chest. But sometimes even healthy people can experience this as a result of excessive exercise or after consuming too much caffeine (coffee, tea, energy drinks). However, if this occurs at rest and it is a prolonged fast heart rate, then it can be result of abnormal thyroid function. On the other side, palpitations can occur in other types of heart disease, but if they are caused by hyperactivity of the thyroid gland, that does not necessarily mean that there is a serious underlying heart disease. In some patients prolonged heart stimulation with thyroxine may cause a lack of coordination of conduction of electrical impulses within the heart which can lead to an episode of atrial fibrillation may result. This occurs when pulses from the right atrium, instead of being routed normally into the ventricles, short-circuit the atria and turn rapidly in circles, causing an inadequate atrial contraction, a loss of regular stimulation of ventricles and irregular heartbeats. Prolonged stimulation of the heart’s contraction can cause a rise in blood pressure called systolic hypertension. Normally, the diastolic blood pressure is not higher in these patients. The accelerated contraction of the heart, which results in increased cardiac output, makes it easy to feel the pulse on the wrist and contributes to the moist heat of the hands.

Complications of hyperthyroidism

 Prolonged untreated stimulation of heart rate and contractions can lead to the following two complications: angina pectoris and heart failure. Angina occurs when the heart muscle does not get enough oxygen, which causes discomfort in the center of the chest, which can also be felt in the throat, neck or jaw, and in the arms (often the arm left). In severe cases, the individual does not feel a simple discomfort but a real pain. If this pain is not treated, it can result in a true heart attack or myocardial infarction, which damages an area of ​​the heart muscle in an irreversible way and it can be fatal. Heart failure can occur when the increased effort required of the heart by rapid electrical stimulations and increased contractions causes a weakening of the heart muscle which then can no longer efficiently pump blood from the lungs to the rest of the body. The usual symptom is therefore shortness of breath due to congestion of blood in the lungs. One of symptoms also can be a swelling of the ankles. Usually, angina pectoris and congestive heart failure do not occur in young hyperthyroid patients whose heart is healthy and strong. However, in older patients with underlying heart disease, the presence of an overactive thyroid gland may be sufficient to unmask the underlying heart disease and worsen the symptoms that are already present.

Effects of alcohol consumption on cardiovascular system

Light to moderate alcohol consumption – up to one drink per day for a woman and 1-2 glasses per day for a man – would be expected to reduce mortality, risk of coronary heart disease, diabetes or stroke prevalence. Is alcohol good or bad for your health and how much should you drink?

 American researchers who publish an article on this subject in Mayo Clinic Proceedings confirm that cardiovascular benefits are observed with a light to moderate consumption of alcohol, ideally of red wine taken before or during the evening meal. But the most important thing in their research is dose of alcohol that people consume and serious toxic effect in an exposed individual. The overconsumption of alcohol is in fact is linked to serious pathologies: cirrhosis, stroke, cancers of the colon/rectum, breast, larynx and liver. Alcohol also increases violence and the risk of traffic accidents.

Regarding general mortality, a meta-analysis involving 1,2 million people found that small amounts of alcohol to moderate alcohol consumption was associated with decreased mortality: the maximum protection was raised with half to one drink per day for women and 1 to 2 glasses a day for men. But 2.5 glasses a day for women and 4 a day for men increased the risk of death.

The benefits do NOT outweigh the risks

alcohol consumption impact on cardiovascular health

Chronic consumption of alcohol in large amounts can lead to a condition called alcoholic cardiomyopathy. Consume a lot of alcohol (four to five drinks a day for several years) leads to weakening of the heart muscle.  This weakening becomes even more important when a person consumes alcohol in excessive amounts.  Excessive consumption of alcohol (on the same occasion, four or more drinks for women, and five or more drinks for men) and heavy alcohol consumption can increase blood pressure and the risk of developing arrhythmias (irregular heartbeat), such as atrial fibrillation. Such alcohol consumption can increase the risk of death, whether or not the person has heart disease. People who survive a heart attack and report excessive alcohol use are twice as likely to die of any condition, including heart disease, as those who do not consume alcohol excessively. There is no doubt that excessive alcohol consumption, even once a week, puts you at higher risk for heart disease or stroke.  We tend to minimize this point, but if you are trying to lose weight healthily, reducing your alcohol intake can save you a lot of calories. Light and non-alcoholic beers are a better choice than standard beers when it comes to caloric and alcohol content.

Summary and conclusions

If you do not consume alcohol, you do not deprive yourself of any benefit and it is not recommended that you change your good habits. The risk of cancer, liver disease, pancreatitis, accidents, suicide and exposure to violence are also important negative effects of alcohol. 

There are better ways to reduce the risk associated with heart disease, such as exercising, eating a balanced diet, and quitting smoking and alcohol at the same time. All of these methods offer benefits without the added risks associated with alcohol consumption. However, consuming a small amount of alcohol from time to time is not necessarily detrimental to your health, ergo, moderation is the solution.  As there are some exceptions, it is important to talk to your doctor and pharmacist about your use of alcohol. Some people should avoid taking it to avoid aggravating their condition. Mixing alcohol and certain medications can also cause dangerous side effects that can be fatal.

Modifying alcohol consumption

Limit your alcohol consumption in the following ways:  two drinks a day most days, for a maximum of 10 per week for women and three drinks a day most days, for a maximum of 15 per week for men.  Consumption is:  341 ml or 1 bottle of beer at normal alcohol level (5%), 142 ml or 5 oz of wine (12% alcohol) 43 ml or 1½ oz of spirits (40% alcohol content). Chronic consumption of alcohol can raise blood pressure and contribute to the development of heart disease and stroke.  If you drink alcohol, avoid taking more than:  two drinks a day for up to 10 drinks a week for women  and three drinks per day for up to 15 drinks per week for men

Take care of your health and safety. If you are worried about the effects of alcohol on your health, consult your doctor or pharmacist.

Effects of nicotine on cardiovascular system

It is clearly established that tobacco and nicotine has increased mortality and cardiovascular events (CV), however, the price of smoking is often neglected. Behavioral interventions and stop assisting treatments are effective and do not increase the risk of CV events when used over a specified period. E-cigarettes (or vaporettes) contain potentially cardiotoxic substances but lower concentrations than those of cigarettes. The CV effect of vaping is difficult today to evaluate and depends on the type of device used and its mode of consumption. Consumers have been advised to quit using sprays and it is recommended that they be discontinued as soon as they are stabilized.

nicotine structure

Smoking is one of the major cardiovascular (CV) risk factors. Despite the fact that the link between smoking and cardiovascular disease (CVD) has been known for more than 60 years, 1 tobacco still kills nearly 5 million people every year according to WHO. According to estimates by the Federal Statistical Office, 9,500 deaths in Switzerland in 2012 are attributable to diseases caused by tobacco, which represents 1 out of 7.3 deaths CVD accounts for 39% of the causes of tobacco-related deaths (15 % of ischemic heart disease, 24% of other CVD). Despite this, the prevalence of smoking remains high even among people with a CV event. Smoking cessation is one of the recommendations for primary and secondary prevention.  In this article, we will consider the CV effects of smoking, the CV benefits of stopping as well as the effectiveness and possible risks of some cessation aid treatments.

What are the health effects of cigarette smoking?

 Smoking has 5 main adverse effects on your cardiovascular system: 

  • Cigarettes significally reduces the concetration of oxygen in the blood, causing shortness of breath and impaired functioning of your muscles.
  •  It hurts your arteries, which lose their ability to expand normally. It also causes spasms (sudden narrowing of the caliber of the artery) that potentially can be fatal.
  • It can cause blood clotting and promotes, among other things, the formation of clots and thus the potential release of an infarct, a phlebitis or a stroke (stroke). 
  • It causes inflammation of the blood vessels, a phenomenon that also promotes the formation of clots and atherosclerosis.
  • It lowers the level of good cholesterol, which is an additional risk factor for your cardiovascular system in the long term. In fact, the good cholesterol or HDL-cholesterol acts as a “scavenger of the arteries” by cleaning the plaque that forms there. 

Smoking also has an indirect effect: the relative loss of taste and smell associated with tobacco promotes smoker’s attraction to more tasty foods, usually much richer in saturated (bad) fats and more salty. However, a diet high in salt and saturated fat further increases the risk of developing cardiovascular disease.

The pathophysiology of cigarette smoking and cardiovascular disease

Nicotine is naturally occurring liquid alkaloid. An alkaloid is an organic compound made out of carbon, hydrogen, nitrogen and sometimes oxygen, and it can have potent effects on human body. Nicotine is a major addictive ingredient found in all tobacco products. Nicotine primarily binds to nicotinic cholinergic receptors in the brain and acts as a sympathomimetic substance. As a result, it stimulates the release of catecholamines (epinephrine, norepinephrine), which lead to an increase in heart rate, blood pressure and myocardial contractility, which in turn increases myocardial work  and oxygen requirements. Nicotine has a toxic effect on the endothelium and, acting also on alpha-adrenergic receptors, causes vasoconstriction. This leads to a decrease in arterial, coronary and cerebral flows. The harmful effects of nicotine are mainly due to long-term consumption and affect the overall health of the body.

As nicotine narrows the blood vessels and also lower the temperature of the skin (it also leads to increased sweating). The increased blood pressure permanently increases the risk of clot formation. Indirectly, nicotine also promotes the development of arteriosclerosis. Thus, there are numerous gases and substances (for example nitrogen monoxide) in tobacco smoke, which are deposited in the vessels and harden them. This reduces the oxygen supply to the vessels and leads to loss of function. In the further course it can come to a complete stop of the blood supply of individual body regions, which can cause sometimes the death of body parts. As arteriosclerosis also affects the heart, it increases the risk of heart attack. A lack of blood flow in the brain increases the risk of stroke and has a negative effect on the health of the brain. Overall, the cardiovascular system also suffers from red blood cells taking up carbon monoxide instead of oxygen. Thus, there is a shortage of oxygen throughout the body, which among other things accelerates cell death.

The chemical process of burning tobacco creates high levels of harmful chemicals, CO is one among them. It binds to hemoglobin more easily than oxygen, thus decreasing the oxygenation of different organs resulting in moderate hypoxemia that can lead to ischemic events. Erythrocyte production is stimulated by hypoxemia, causing hyperviscosity that contributes to hypercoagulability.  The smoke contains a considerable number of oxidizing gases. These lead to inflammation, endothelial dysfunction and lipid oxidation, which contributes to the pathogenesis of CVD. Oxidizing gases also participate in platelet activation and thermogenesis and increase coagulability. Other components of the smoke, such as heavy metals and polycyclic aromatic hydrocarbons, destroy endothelial cells and contribute to the progression of atherosclerosis.

Nicotine substitutuion

The cardiovascular effects of cigarettes are well known and preventable. They are caused by nicotine, CO, heavy metals on the other side nicotine substitutes contain low dose nicotine and are relatively safe to use even in people with CV risk. Precautions are required during a severe acute cardiac event, but even in these situations, the use of nicotine replacement therapy remains preferable to smoking. Data on the efficacy and safety of varenicline in CVs are favorable. With respect to vaping, the exposure to nicotine and other compounds in the vapor differs with respect to the type and generation of the device and its use. It is therefore extremely difficult to generalize the results of the studies. In addition to nicotine, other substances in the liquid may have a CV effect. The CV toxicity of the vapote nevertheless seems to be lower compared to cigarettes but medium and long term data on the CV safety of the current devices are necessary. In the meantime, it is recommended that people who have quit smoking by vaporettes stop using them as soon as the cessation of smoking is consolidated and that they feel confident enough not to relapse.

Retinopathy

Retinopathy refers to any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to a retinal vascular disease, or the damage to the vessels of the retina caused by abnormal blood flow. Retinopathy can be broadly categorized into proliferative and non-proliferative types. By examining the retina, the light-sensitive layer at the back of the eyes, a doctor can detect early signs of complications of diabetes or high blood pressure, as well as other diseases (such as sickle cell disease, anemia, lupus).

Types of the damage that can occur in the retina are hypertensive retinopathy, a complication of high blood pressure (hypertension), and diabetic retinopathy, a complication of long-term diabetes. Hypertensive retinopathy can lead to blockage of retinal arteries or veins, which in turn may eventually result in the loss of vision. Smoking and diabetes increase the risk of developing hypertensive retinopathy. Diabetic retinopathy is a deterioration of the blood vessels in the retina that usually affects both eyes. Diabetes is the most common cause of retinopathy in the U.S. Diabetic retinopathy is the leading cause of blindness in working-aged people. Almost all people with diabetes show signs of retinal damage after about 20 years of living with the condition. Retinopathy can also be seen in premature newborns.

retinopathy

Causes of retinopathy

Retinopathy is usually a sign of another medical condition. Although several medical conditions (sickle cell disease, lupus) can cause retinopathy, the most common causes are diabetes and hypertension.

Diabetic retinopathy is one of the most common complications of diabetes. Diabetes causes high blood sugar levels, which can damage blood vessels around the retina, that then leak protein and fats, forming deposits. The damaged blood vessels are also not as efficient at carrying oxygen to the retina. Diabetic retinopathy can be proliferative (growing abnormal blood vessels in the retina) or non-proliferative (not growing). Non-proliferative retinopathy is much more common and may not require treatment. In the advanced stage, called proliferative retinopathy, new blood vessels grow, when the existing vessels close off. However, they are weak and often burst, causing bleeding, which can cause scarring and damage vision. Regular eye examinations are important to check for progression of retinopathy from non-proliferative to proliferative stages. Diabetic retinopathy usually affects both eyes.

Hypertensive retinopathy is a complication of high blood pressure that usually takes many years to develop. High blood pressure damages the blood vessel walls, causing them to thicken and narrow, which then reduces the blood supply available to the retina, leading to retinal damage. Visual changes sometimes develop because of advanced retinopathy and may be a sign of undiagnosed or poorly controlled hypertension.

Signs and symptoms

Many people often do not have symptoms until there is irreversible damage. Symptoms are usually not painful and can include:

•    Spots or dark strings floating in your vision (floaters)

•    Blurred vision

•    Fluctuating vision

•    Impaired color vision

•    Eye pain and redness that does not resolve

•    Decreased peripheral vision

•    Changes in color perception

•    Headaches

The earliest sign of diabetic retinopathy that can be detected is the formation of microaneurysms. A more advanced form of diabetic retinopathy, called proliferative diabetic retinopathy, may lead to scars that decrease vision. In proliferative retinopathy, new blood vessels grow over the retina, these blood vessels may swell and burst, causing bleeding and damage to the eye.

Diagnosis and treatment

Retinopathy is diagnosed by an ophthalmologist during a comprehensive dilated eye exam that usually includes: visual acuity testing, tonometry, pupil dilation and optical coherence tomography (OCT). If severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damage or leakage in blood vessels. In the case of hypertensive retinopathy, an ophthalmologist will look for tiny cholesterol plaques as well as narrowing and thickening of the blood vessels.

The key to treating retinopathy is managing the underlying causes behind this condition. Controlling blood sugar levels in diabetes is critical in delaying the progression of diabetic retinopathy. Keeping blood pressure under control will help prevent hypertensive retinopathy. Regular exercise, proper diet, supplements and other lifestyle changes such as quitting smoking will reduce the risk of developing retinopathy. Once retinopathy is detected, early treatment is essential to prevent blindness.

Today, many retinal problems are treated with lasers. Evidence shows that laser therapy is generally safe and improves visual symptoms. If a blood vessel has already leaked and scarring has occurred, your doctor may advise you to have a vitrectomy, which involves removing a part of the vitreous humour along with the scar tissue. Treatment for hypertensive retinopathy includes medications to control blood pressure, laser treatment, and medications injected into the eye (corticosteroids).

Essential hypertension

Essential hypertension (called idiopathic hypertension or primary hypertension) is the form of hypertension that has no identifiable cause. It is usually familial and is likely to be the consequence of a complex interaction between genetic and environmental factors. The other type of hypertension is secondary hypertension. Secondary hypertension is high blood pressure that has an identifiable cause, with a prevalence of 5% of patients with hypertension.

Blood pressure is the force of the blood against the artery walls as the heart pumps blood through the body. Hypertension occurs when the force of blood is stronger than usual. Hypertension can increase the risk of cerebral, cardiac and renal events.    

Risk factors

By the definition essential hypertension has no identifiable cause, however, several risk factors were identified. The list of risk factors:

  • Age: The risk of high blood pressure increases by aging. Until about the age of 64, essential hypertension is more common in men. Women are more likely to develop essential hypertension after the age of 65.
  • Race: Essential hypertension is four times more common among people of African heritage. It accelerates more rapidly and with a higher rate of serious complications in people of African heritage.
  • Family history: A personal family history of hypertension increases the likelihood that an individual would develop it.
  • Being overweight or obese:  Obesity can increase the risk of hypertension as compared with normal weight. More than 85% of cases occur in patients with a Body Mass Index (BMI) greater than 25. The mechanisms could include the activation of the sympathetic nervous system or the activation of the renin–angiotensin–aldosterone system.
  • Lack of exercise: Regular physical exercise reduces blood pressure, and at the same time increases the risk of being overweight.
  • Smoking:  Smoking doesn`t directly cause high blood pressure but it is a known risk factor for serious cardiovascular disease. Secondhand smoke also can increase the risk of developing heart disease.
  • Salt:  When sodium intake exceeds the capacity of the body to excrete it through the kidneys, vascular volume expands and this leads to an increase of blood pressure.
  • Alcohol: Over time, excessive alcohol consumption can damage the heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
  • Stress: High levels of stress can lead to a temporary increase in blood pressure.

Classification

The most recent classification recommends blood pressure criteria for defining normal blood pressure, prehypertension, hypertension (stages I and II), and isolated systolic hypertension. Blood pressure readings are described with two numbers, usually written this way: 120/80. The first number is systolic pressure. Systolic pressure measures the force of blood against artery walls as the heart pumps blood to the body. The second number measures diastolic pressure, which is the force of the blood against the artery walls between heartbeats, as the heart muscle relaxes.

Normal blood pressure is measured less than 120/80 millimeters of mercury (mmHg). Elevated blood pressure is higher than normal, but not quite high enough to be hypertension. Elevated blood pressure is a systolic pressure of 120 to 129 mmHg, a diastolic pressure less than 80 mmHg. Stage 1 hypertension is a systolic pressure of 130 to 139 mmHg, or a diastolic pressure of 80 to 89 mmHg. Stage 2 hypertension is a systolic pressure higher than 140 mmHg, or a diastolic pressure higher than 90 mmHg.

Diagnosing

For most patients, high blood pressure is diagnosed when blood pressure readings are consistently 130/90 mmHg or above. A blood pressure reading can be done in the doctor`s office or at the clinic. To track blood pressure readings over a period of time, the doctor may ask the patient to come on different days and at different times. If the blood pressure is high, the doctor may want from a patient to check his blood pressure at home during regular intervals. It usually takes 2–3 readings at several medical appointments to diagnose high blood pressure.

The doctor can perform a physical exam to check for signs of heart disease, and may also order the following test to detect organ damage:

  • Cholesterol test
  • Echocardiogram
  • Electrocardiogram (EKG or ECG)
  • Kidney and other organ function tests

Treatment

There’s no cure for essential hypertension, but there are treatments that can help manage high blood pressure and keep it under control. The treatment consists of lifestyle changes and medication. Recommended lifestyle changes are the following: exercising at least 30 minutes a day, losing weight, quit smoking, reducing stress levels, limiting alcohol intake, eating a low-sodium, heart-healthy diet (recommended DASH diet). If these lifestyle changes don’t lower the blood pressure levels enough, the doctor may prescribe one or more antihypertension medications, such as: beta-blockers, calcium channel blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers.

Complications

The excessive pressure on the artery walls caused by high blood pressure can damage the blood vessels, as well as the organs. Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke
  • An aneurysm
  • Heart failure
  • Weakened and narrowed blood vessels in the kidneys
  • Thickened, narrowed or torn blood vessels in the eyes
  • Metabolic syndrome
  • Dementia

With a healthy lifestyle and medication, there’s a good chance that you can control your blood pressure. Controlling essential hypertension reduces the risk of a heart attack, stroke, heart failure, damage to the eyes or kidneys. If you already have organ damage the treatment would help limit further damaging.