What is cardiovascular disease? Peripheral artery disease

As you know, cardiovascular diseases occupy first place among the most common and dangerous diseases of our time. There are many reasons for this, but the main ones are genetic predisposition and poor lifestyle.

Cardiovascular diseases are numerous, occur in different ways and have different origins. They can occur as a result of inflammatory processes, birth defects development, injuries, intoxication, pathological changes metabolic processes, as well as as a result of reasons that are poorly understood at present.

However, with such a variety of causes of diseases associated with disruption of the cardiovascular system, these diseases share common symptoms that appear in these pathologies. Therefore, there are general rules recognizing the first signs of the disease. They need to be known in order to be able to avoid complications, and sometimes the disease of the cardiovascular system itself.

The main ones that allow us to talk about pathology associated with the work of the cardiovascular system:

Pain and discomfort in chest

Pain is one of the most common symptoms of diseases associated with disruption of the cardiovascular system. If the pain is burning, acute, then most often a spasm of the coronary vessels occurs, which leads to insufficient nutrition of the heart itself. Such pain is called angina pectoris. They can occur during physical activity, low temperature, or stress. Angina occurs when the blood flow cannot meet the oxygen needs of the heart muscle. A doctor can recognize angina pectoris, or angina pectoris, already at the patient’s first visit. The situation is worse with the diagnosis of deviations. For correct diagnosis Monitoring of the course of angina pectoris, analysis of questions and examinations of the patient are necessary. Additional research required - daily monitoring ECG (ECG recording during the day).

There are angina pectoris at rest and angina pectoris. Angina at rest is not associated with physical effort, often occurs at night, and has common features with severe attack angina pectoris, often accompanied by a feeling of lack of air. Angina can be stable, when attacks occur with a more or less certain frequency and are provoked by a load of approximately the same degree, as well as unstable, in which an attack occurs for the first time or the nature of the attacks changes: they occur unexpectedly and last longer, signs appear that are atypical for previous attacks ( progressive angina). Unstable angina is dangerous because it can lead to the development of myocardial infarction (MI). Patients with this type of angina must be hospitalized.

We must not forget that an attack of angina can be a harbinger of coronary heart disease (CHD) and myocardial infarction. In this regard, when the first symptoms appear angina pectoris the patient needs to undergo an electrocardiographic examination in the near future, and then carry out medical supervision for further development of angina pectoris. It is believed that such patients require hospitalization to make an accurate diagnosis, as well as to monitor the course of the disease. To detect abnormalities in the heart high result gives the use of a cardiovisor. The services provided by the project site help people independently monitor the dynamics of changes in the functioning of the heart and consult a doctor in a timely manner, even in cases where there are no visible manifestations of the disease.

Severe, prolonged pain in the chest, radiating to left hand, neck and back are characteristic of developing heart attack myocardium. One of the most common causes of myocardial infarction is atherosclerosis of the coronary vessels. Pain during MI is often intense and can be so strong that a person may lose consciousness and go into shock: blood pressure drops sharply, pallor appears, and cold sweat appears.

Severe pain in the chest, radiating to the back of the head, back, sometimes groin area, speaks of an aneurysm, or aortic dissection.

Dull pain in the heart area, sometimes intensifying and then weakening without spreading to other areas of the body, against a background of rising temperature, indicates the development of pericarditis (inflammation of the heart sac - pericardium).

Sometimes pain can occur in the abdominal area, which indicates vascular diseases of the abdominal organs.

With pulmonary embolism (PE), symptoms will depend on the location and size of the clot. The person will feel pain in the chest, radiating to the shoulder, arm, neck and jaw. A common accompaniment of thromboembolism is shortness of breath. Coughing and even hemoptysis may occur. The patient feels weakness and rapid heartbeat.

Dull and short stabbing pain in the region of the heart, which occurs regardless of movements and physical effort, without disturbances in breathing and heartbeat, is typical for patients with cardiac neurosis (neurocirculatory dystopia of the cardiac type).

Heart neurosis is a fairly common disease of the cardiovascular system. This is due to the intense rhythm of our lives and frequent stressful situations. Typically, this disease occurs after nervous overload. Heart pain can last for quite a long time - from several hours to several days. With this pathology, pain is not associated with physical overload, which distinguishes it from pain with angina pectoris. The pain disappears after the person calms down and forgets about the anxiety he suffered. Advanced cases of neurasthenia can lead to angina pectoris.

With cardiac neurosis, except cardiovascular disorders, patients also have functional disorders nervous system - absent-mindedness, increased fatigue, bad dream, anxiety, tremors of limbs.

Acute chest pain may indicate not only diseases associated with disruption of the cardiovascular system, but also be a consequence of other diseases. These include:

Intercostal neuralgia, which is characterized by acute, paroxysmal, shooting pain along the intercostal spaces (where the nerve passes). Pain points located at the exit point of the nerves (to the right and left of the spine). With intercostal neuralgia, skin sensitivity in the intercostal area may be impaired.

Herpes zoster, the appearance of which (the onset of the disease) is accompanied by pain similar to intercostal neuralgia, but often more intense. In the area of ​​pain (in the intercostal space), so-called herpetic blisters appear. The disease is accompanied by an increase in temperature.

Spontaneous pneumothorax, which is characterized by sudden appearance chest pain, and pain accompanied by severe shortness of breath. This disease is typical for people suffering from chronic respiratory diseases (chronic bronchitis, emphysema, etc.). Sometimes it can occur in people who do not suffer from the listed diseases, during heavy physical exertion, or during strong, sharp exhalation.

Cardiospasm (spasm of the esophagus), which, in addition to pain behind the sternum, is characterized by impaired swallowing and belching.

Cervical and thoracic radiculitis, accompanied by severe pain associated with movement (turns, bending of the torso, neck).

Very often, based on a person’s description of pain, a doctor can draw a conclusion about the origin of the disease. A cardiovisor can be an indispensable assistant in this case, which allows you to determine whether the pathology is related to the functioning of the cardiovascular system or not.

Palpitations and a feeling of irregular heartbeat

Strong heartbeat does not always mean the development of some pathology, since it can occur during intense physical activity or as a result of emotional excitement person, and even after consumption large quantity food.

In diseases of the cardiovascular system, palpitations often appear in the early stages of the disease. The feeling of a malfunction of the heart occurs when the heart rhythm is disturbed. At the same time, it seems to a person that the heart either almost “jumps out” of the chest, or freezes for a certain period of time.

Such symptoms of cardiovascular diseases are characteristic of tachycardia, which is accompanied by a palpitation with a distinct beginning and end, the duration of which can be from a few seconds to several days. Supraventricular tachycardia is accompanied by sweating, increased intestinal motility, excessive urination at the end of the attack, slight increase body temperature. Prolonged attacks may be accompanied by weakness, discomfort in the heart, and fainting. If there are heart diseases, then angina pectoris, heart failure. Ventricular tachycardia is less common and is most often associated with heart disease. It leads to impaired blood supply to organs, as well as heart failure. Ventricular tachycardia may be a precursor to ventricular fibrillation.

With heart block, irregular contractions may occur, in particular, “dropout” of individual impulses or a significant slowdown in heart rate. These symptoms may be accompanied by dizziness or fainting due to decreased cardiac output.

Dyspnea

With heart disease, shortness of breath can manifest itself in the early stages. This symptom occurs with heart failure: the heart does not work at full capacity and does not pump required quantity blood through blood vessels. Most often, heart failure develops as a result of atherosclerosis (deposits in blood vessels atherosclerotic plaques). IN mild case forms of the disease, shortness of breath bothers you during intense physical activity. In severe cases, shortness of breath also occurs at rest.

The appearance of shortness of breath may be associated with stagnation of blood in the pulmonary circulation or cerebrovascular accident.

Sometimes cardiac dyspnea is difficult to distinguish from shortness of breath accompanying lung diseases. Both cardiac and pulmonary shortness of breath may worsen at night when a person goes to bed.

In case of heart failure, fluid retention in the body tissues is possible as a result of slowing blood flow, which can cause pulmonary edema and threaten the patient’s life.

Severe obesity, which increases the weight of the chest wall, significantly increases the load on the muscles involved in the breathing process. This pathology leads to shortness of breath, which correlates with physical activity. Since obesity is a risk factor for the development of coronary artery disease and contributes to the formation of blood clots in the veins of the legs with subsequent pulmonary embolism, it is possible to associate shortness of breath only with obesity only if these diseases are excluded.

Detraining plays an important role in finding the causes of shortness of breath in the modern world. Shortness of breath is experienced not only by patients, but also healthy people who lead a sedentary lifestyle. During heavy physical activity, even a normally functioning left ventricle in such people cannot manage to pump all the blood entering it into the aorta, which ultimately leads to stagnation in the pulmonary circulation and shortness of breath.

One of the symptoms neurotic conditions is psychogenic dyspnea, which is easy to distinguish from cardiac dyspnea. People with heart neurosis experience difficulty breathing: they always lack air, and therefore they are forced to periodically deep breaths. It is typical for such patients shallow breathing, dizziness and general weakness. Such breathing disorders are purely neurogenic in nature and are in no way associated with shortness of breath, characteristic of cardiac or pulmonary diseases.

When making a diagnosis, the doctor can easily distinguish psychogenic shortness of breath from cardiac shortness of breath. However, difficulties often arise in the differential diagnosis of psychogenic dyspnea, which differs from the dyspnea characteristic of pulmonary embolism. It is important not to miss the mediastinal tumor and the primary pulmonary hypertension. In this case, the diagnosis is made by exclusion after a thorough examination of the patient.

For precise definition Due to the nature of discomfort in the chest, as well as shortness of breath, they resort to bicycle ergometry or Holter ECG monitoring. A high degree of efficiency in identifying pathologies in the work of the heart can be achieved using a computer system for screening analysis of dispersion changes in the ECG signal, which is offered by the project site.

Edema

The main reason for the appearance of edema is an increase in pressure in the venous capillaries. This is facilitated by reasons such as impaired renal function and increased permeability of vascular walls. If the swelling is mainly in the ankles, this may indicate heart failure.

Cardiac edema will differ between ambulatory and recumbent patients, as it is associated with the movement of interstitial fluid under the influence of gravity. Walking patients are characterized by swelling of the lower leg, which increases in the evening and subsides in the morning, after sleep. With further accumulation of fluid, it spreads upward, and patients experience swelling in the hips, then the lower back and abdominal wall. In severe cases, swelling extends to subcutaneous tissue chest wall, arms and face.

In bedridden patients excess fluid usually first accumulates on the lower back and sacral area. Therefore, patients with suspected heart failure must be turned onto their stomach.

Bilateral symmetrical swelling of the legs, usually appearing after a long stay on one's feet, accompanied by shortness of breath, rapid pulse and wheezing in the lungs, may be a consequence of acute or chronic heart failure. Such swelling, as a rule, spreads from bottom to top and intensifies towards the end of the day. Asymmetrical swelling of the legs occurs with phlebothrombosis - the most common cause of pulmonary embolism, which can lead to overload of the right ventricle.

There are several ways to determine whether your legs are swollen. Firstly, after removing clothes, in places where they are pinched, for example, by the elastic bands of socks, there are pits that do not go away immediately. Secondly, within 30 seconds after pressing with a finger on the front surface of the leg, at the place where the bone is closest to the surface of the skin, even with slight swelling, a “pit” remains, which does not go away for a very long time. To accurately determine the cause of swelling, you need to visit a therapist. He will be able to determine which specialist should be contacted first.

Discoloration of the skin (pallor, cyanosis)

Pallor is most often observed with anemia, vasospasm, severe rheumatic carditis (inflammatory damage to the heart due to rheumatism), and aortic valve insufficiency.

Blueness (cyanosis) of the lips, cheeks, nose, earlobes and limbs is observed when severe degrees pulmonary heart failure.

Headaches and dizziness

These symptoms very often accompany diseases associated with disorders of the heart and blood vessels. The main reason for this response from the body is that the brain does not receive the required amount of blood, and therefore there is not sufficient oxygen supply to the brain. In addition, cells are poisoned by decay products that are not taken from the brain by blood in a timely manner.

A headache, especially a throbbing one, may indicate increased blood pressure. However, in other cases it can be asymptomatic. Increased pressure must be treated, as it can lead to myocardial infarction and sometimes stroke.

Inflammatory processes (myocarditis, pericarditis, endocarditis) and myocardial infarction are accompanied by an increase in temperature, sometimes fever.

Problems with the heart may also be indicated by poor sleep, clammy sweat, restlessness, nausea and discomfort in the chest when lying on the left side, as well as a feeling of weakness and increased fatigue body.

If you have the first suspicion of problems related to the functioning of the heart, you should not wait for them to appear. visible symptoms, since many diseases of the cardiovascular system begin with a person’s feeling that “something is wrong” in the body.

Everyone should remember the need for early diagnosis, because it is no secret that the earlier the disease is detected, the easier and with the least risk to the patient’s life the treatment will be completed.

One of the most effective means of early detection of cardiovascular diseases is the use of a cardiovisor, since when processing ECG data, a new patented method for analyzing microalterations (microscopic tremors) of the ECG signal is used, which makes it possible to identify deviations from the norm in the functioning of the heart in the early stages of the disease.

It is well known that the disease often develops, one might say, completely unnoticed by the patient and is detected only during examination by a cardiologist. This fact indicates the need for preventive visits to a cardiologist at least once a year. However, research is required ECG results. If, when examining a patient, a cardiologist will have the opportunity to analyze the results of an electrocardiogram taken immediately upon the occurrence of symptoms of cardiovascular diseases, then the probability of making a correct diagnosis, and therefore carrying out proper treatment will increase significantly.

Rostislav Zhadeiko, especially for the project.

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Diseases of the cardiovascular system are widespread among the adult population of many countries around the world and occupy a leading place in overall mortality statistics. This problem mainly affects countries with middle and low income levels - 4 out of 5 deaths from cardiovascular pathology were residents of these regions. To the reader who does not have medical education, costs at least general outline understand what this or that heart or vascular disease is, so that if you suspect its development, do not waste precious time, but immediately seek help medical care. To learn the signs of the most common diseases of the cardiovascular system, read this article.

Atherosclerosis

According to WHO definition ( World Organization healthcare), is a constantly increased blood pressure: systolic – above 140 mm Hg. Art., diastolic – above 90 mm Hg. Art. The blood pressure level at diagnosis should be determined as the average of two or more measurements during at least two examinations by a specialist on different days.

Essential hypertension, or essential hypertension, is high blood pressure in the absence of obvious reason raising it. Accounts for about 95% of all cases of arterial hypertension.

Main risk factors of this disease are the same factors that contribute development of ischemic heart disease and, aggravate the course hypertension the following accompanying pathology:

  • diabetes mellitus;
  • cerebrovascular diseases - ischemic or hemorrhagic strokes (TIA);
  • heart diseases – myocardial infarction, angina pectoris, heart failure;
  • kidney diseases - diabetic nephropathy;
  • peripheral arterial disease;
  • retinal pathology – disc edema optic nerve, hemorrhages, exudates.

If a patient suffering from hypertension does not receive therapy that helps lower blood pressure, the disease progresses, hypertensive crises occur more and more often, which sooner or later can cause all sorts of complications:

  • acute hypertensive;
  • pulmonary edema;
  • myocardial infarction or unstable angina;
  • stroke or transient ischemic attack;
  • aortic dissection;
  • eclampsia - in pregnant women.

Secondary, or symptomatic, hypertension is a persistent increase in blood pressure, the cause of which can be determined. It accounts for only 5% of cases of arterial hypertension.

Of the diseases that lead to high blood pressure, the most commonly diagnosed are:

  • kidney tissue damage;
  • adrenal tumors;
  • diseases renal arteries and aorta (coarctation);
  • pathology of the central nervous system (brain tumors, polyneuritis);
  • (polycythemia);
  • pathology thyroid gland(-, -, hyperparathyroidism) and other diseases.

Complications of this type of arterial hypertension are the same as with hypertension, plus complications of the underlying disease that provoked hypertension.

Heart failure

A common pathological condition that is not independent disease, but there is a consequence, an outcome of other acute and chronic heart diseases. At this state Due to changes in the heart, its pumping function is disrupted - the heart is unable to supply all organs and tissues with blood.

Complications of heart failure are:

  • arrhythmias;
  • congestive;
  • thromboembolism;
  • chronic renal failure(the so-called “stagnant kidney”);
  • cardiac cachexia (exhaustion);
  • cerebrovascular accidents.

Acquired heart defects

Acquired heart defects occur in approximately 1-10 people per 1000 population, depending on the region of residence, and account for about 20% of all heart lesions of an organic nature.

The main reason for the development of acquired heart defects is rheumatic lesion valves: 70-80% of all defects are pathology of the mitral valve, the second place in the frequency of damage belongs to the aortic valve, stenosis and/or insufficiency of the tricuspid valve and pulmonary artery valve are relatively rarely diagnosed.

This pathology affects people of different age groups. Every 2nd patient with heart disease requires surgical treatment.

The essence of the disease is that under the influence etiological factors Heart valves lose their ability to function normally:

  • stenosis is a narrowing of the valve, as a result of which it does not allow enough blood to pass through, and the organs experience a lack of oxygen, or hypoxia;
  • insufficiency - the valve leaflets do not close completely, as a result of which blood is thrown from the part of the heart located below to the part located above; the result is the same - the organs and tissues of the body do not receive the vital oxygen they need, and their function is impaired.

Complications of heart defects include many conditions, among which the most common are acute, infectious bronchopulmonary complications, chronic failure blood circulation, atrial fibrillation, thromboembolism and others.

Clinically, myocarditis is manifested by attacks of chest pain, signs of valve pathology, symptoms of arrhythmias, and circulatory disorders. May be asymptomatic.

The prognosis for this disease depends on the severity of its course: mild and moderate forms, as a rule, end full recovery patient within 12 months after the onset of the disease, severe ones can lead to sudden death, refractory circulatory failure and thromboembolic complications.

Cardiomyopathies

Cardiomyopathies are independent, steadily progressing forms of damage to the heart muscle of unclear or controversial etiology. Within 2 years, about 15% of patients die from some forms of this disease in the absence of symptoms, and up to 50% in the presence of symptoms corresponding to the disease. They are the cause of death in 2-4% of adults, and are also the leading cause of sudden death in young athletes.

The probable causes of cardiomyopathies are:

  • heredity;
  • infection;
  • metabolic diseases, in particular glycogenosis;
  • lack of certain substances in the diet, in particular selenium, thiamine;
  • pathology endocrine system(diabetes mellitus, acromegaly);
  • neuromuscular pathology (muscular dystrophy);
  • exposure to toxic substances - alcohol, drugs (cocaine), certain medications (cyclophosphamide, doxorubicin);
  • diseases of the blood system (some types of anemia, thrombocytopenia).

Clinically, cardiomyopathies manifest themselves all sorts of symptoms cardiac dysfunction: angina attacks, fainting, palpitations, shortness of breath, cardiac arrhythmias.

Cardiomyopathy is especially dangerous due to the increased risk of sudden death.


Pericarditis

– this is an inflammation of the layers of the lining of the heart - the pericardium - of infectious or non-infectious etiology. Areas of the pericardium are replaced fibrous tissue, exudate accumulates in its cavity. Pericarditis is divided into dry and exudative, acute and chronic.

Clinically manifested by chest pain, shortness of breath, fever, muscle pain, combined with signs of the underlying disease.

The most dangerous complication of pericarditis is cardiac tamponade - the accumulation of fluid (inflammatory or blood) between the layers of the pericardium, preventing normal contractions hearts.

Infective endocarditis

Represents inflammatory lesion valve structures with subsequent spread to other organs and systems, resulting from the introduction of a bacterial infection into the structures of the heart. This disease is the 4th leading cause of death in patients from infectious pathology.

In recent years, the incidence of infective endocarditis has increased significantly, which is associated with a wider spread of surgical interventions on the heart. It can occur at any age, but it most often affects people between 20 and 50 years of age. The ratio of incidence between men and women is approximately 2:1.

Infective endocarditis is a potentially life-threatening disease, therefore timely diagnosis it, adequate, effective treatment and rapid identification of complications are extremely important to improve the prognosis.

Arrhythmias


As a rule, arrhythmia is not an independent pathology, but a consequence of other cardiac or non-cardiac diseases.

Heart rhythm disturbances are not separate diseases, but are manifestations or complications of any pathological conditions associated with heart disease or non-cardiac pathology. They can long time may be asymptomatic, but may pose a danger to the patient’s life. There are many types of arrhythmias, but 80% of them are due to extrasystole and atrial fibrillation.

Clinically, arrhythmias are manifested by a feeling of interruptions in the work of the heart, dizziness, shortness of breath, weakness, a feeling of fear, and others. unpleasant symptoms. Their severe forms can provoke the development of cardiac asthma, pulmonary edema, arrhythmogenic cardiomyopathy or arrhythmic shock, and also cause sudden death of the patient.

Which doctor should I contact?

Diseases of the cardiovascular system are treated by a cardiologist. They are often combined with pathology endocrine glands, therefore, consultation with an endocrinologist and nutritionist will be useful. A cardiac surgeon is often involved in the treatment of patients. vascular surgeon. Patients must be examined by a neurologist and an ophthalmologist.

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Diseases of the cardiovascular system are among the most dangerous for humans. Every year, 17.5 million people worldwide die from heart problems. Such a sad result is predictable: stress, poor nutrition, bad habits - all this negatively affects the functioning of our body.

What exactly can lead to heart disease? How do they develop? And what types of cardiovascular diseases are especially common?

Types of cardiovascular diseases

Cardiovascular diseases are divided into seven types:

  1. Rhythm and conduction disorders. They are associated with diseases such as cardiac arrhythmia, bundle branch block, cardiac fibrillation, etc.
  2. Inflammatory heart diseases: endocarditis, myocarditis, pericarditis. All of these diseases are associated with inflammation different parts heart: the inner lining - the endocardium, the cardiac muscle - the myocardium and the connecting lining of the heart - the pericardium.
  3. Valve defects. This type of heart disease is divided into two subtypes: congenital and acquired defects. Congenital defects arise due to genetic disorders or damage to the fetus; acquired ones are most often associated with infectious lesions of the body or autoimmune reactions.
  4. Arterial hypertension. This subgroup of diseases is associated with a persistent increase in blood pressure.
  5. Ischemic lesions. Such diseases are associated with a complete or partial decrease in blood flow to the heart muscle. In the first case, the patient will have a myocardial infarction, in the second, coronary heart disease will develop.
  6. Damage to the blood vessels of the heart: cardiosclerosis, coronary heart disease, atherosclerosis.
  7. Pathological changes– these are diseases associated with irreversible changes in the functioning of the heart. For example, cardiac asthma and failure, hypertrophy of different parts of the heart.

The most common diseases of the cardiovascular system

The extensive list of diseases in this group includes those that we encounter. Thus, according to statistics, out of 17.5 million deaths from CVD, about 7 million people die annually from coronary heart disease, and 6.5 million people die from stroke.

In addition to ischemic heart disease and stroke, the list of the most common diseases includes:

  1. peripheral artery disease
  2. rheumatic carditis
  3. heart defect
  4. hypertension
  5. deep vein thrombosis and pulmonary embolism

We'll tell you about them today.

Diseases of the cardiovascular system: types and features

1. Peripheral artery disease

Peripheral artery disease is a disease of the blood vessels that supply blood to the legs and arms. In the early stages, the patient may complain of increased sensitivity To low temperatures, coldness in the extremities, a feeling of numbness or tingling, and fatigue or pain in the arms and legs.

In later stages of the disease, intermittent claudication appears - quite severe pain in the muscles of a certain group, causing them to stop moving.

Pain occurs due to insufficient blood flow to the muscles. Up to the third stage of the disease, the pain goes away after a short rest, when the load disappears and the blood supply becomes sufficient. In the third and fourth stages of the disease, pain may occur at rest, and ulcers and necrosis may also open.

What to do? Stop smoking, control your weight, reduce your intake of easily digestible carbohydrates, animal fats and cholesterol, and regularly walk for at least one hour a day.

2. Rheumatic carditis

Rheumatism of the heart or rheumatic carditis is a disease connective tissue affecting all layers of the heart. Rheumatic carditis begins with a typical sore throat caused by group A streptococcus. Scarlet fever, pneumonia and other diseases of the respiratory system may also occur. Rheumatism attacks approximately 2 - 3 weeks after the infection.

Rheumatic carditis is manifested by “volatile” (moving and intermittent) pain in the joints, tachycardia and arrhythmia, pain in the heart, as well as signs of heart failure: swelling of the legs, shortness of breath at rest, a blue tint to the skin, and a wet cough.

What to do? Treatment and prevention of rheumatic carditis is carried out mainly with medications and is aimed at combating streptococcal infection. For prophylaxis, more gentle antibacterial and anti-inflammatory drugs are prescribed. Traditional methods for the treatment of rheumatic carditis are not recommended.

3. Heart defect

Congenital heart disease is a fairly common disease. Modern babies are often born with this disease and sometimes spend their entire lives fighting it. But heart disease does not always occur in infancy; many adults experience it due to other untreated CVDs.

Acquired heart disease is a disease associated with disruption of the structure and function of the heart valve apparatus and leading to changes in intracardiac circulation.

Acquired heart defects develop as a result of acute or chronic diseases (rheumatism, sepsis, atherosclerosis, syphilis) and injuries that disrupt the activity of valves and change the movement of blood through the vessels.

Most often, acquired heart disease affects mitral valve: between the left atrium and the left ventricle. Less commonly, the aortic valve. It separates the left ventricle and the aorta.

What to do? To prevent heart disease, it is necessary to treat emerging heart diseases and monitor your condition: get rid of bad habits, lose weight, play sports or exercise the body using various types of breathing exercises.

If a defect occurs, drug treatment is prescribed to relieve symptoms, as well as surgery to correct valve defects.

4. Hypertension

High blood pressure worries most of the world's population. This comprehensive problem, although not as dangerous as a stroke or heart attack, can easily cause them, which is why it is so important to monitor your blood pressure and find out why it is rising.

Hypertension can manifest itself as headaches, dizziness, sweating, redness of the face, spots before the eyes, irritability, etc.

What to do? In the early stages, hypertension can be controlled without medications. It is enough to give up bad habits and moderate your consumption fatty foods, move more.

If you feel that the condition is worsening, consult a doctor. He will write out necessary medications and will tell you what to do to prevent the development of the disease.

Don't forget that no treatment will be effective without you working on yourself. Be sure to watch your lifestyle and do not avoid small physical activities. If it’s already hard for you to make friends with sports, do breathing exercises or buy a breathing simulator.

5. Deep vein thrombosis and pulmonary embolism

Deep vein thrombosis is a disease in which blood clots form in the deep veins ( blood clots). Most often they appear in the lower leg, pelvis and thighs. Thrombosis can cause chronic venous insufficiency, swelling of the legs, trophic ulcers and eczema.

The most dangerous manifestation thrombosis – pulmonary embolism, when parts of a blood clot break off and travel to the lungs, causing a blockage. This disrupts blood flow and leads to cardiac and acute respiratory failure, which can lead to instant death of the patient or pulmonary infarction.

What to do? If you are at risk of thrombosis (age, pregnancy, craving for smoking, prolonged bed rest, excess weight), then you should see a doctor and follow the recommendations of a specialist.

They may concern both medications (anticoagulants are prescribed) and non-drug prevention. For example, wearing compression garments, drinking plenty of fluids, warming up during long trips.

Cardiovascular diseases are difficult to control, but not impossible. The main thing is to control yourself and remember that health is more important than a smoked cigarette or another cake. A healthy lifestyle is the key healthy heart. Don't forget about it and subscribe to our blog to read interesting articles every week.

We offer our method of treating diseases of the cardiovascular system using breathing exercises on the simulator. You can find out more about it by going to.

Article publication date: 03/02/2017

Article updated date: 12/18/2018

From this article you will learn: what types of heart diseases are there (congenital and acquired). Their causes, symptoms and treatment methods (medical and surgical).

Cardiovascular diseases are one of the leading causes of death. Russian statistics show that about 55% of all deceased citizens suffered from diseases of this group.

So know the signs cardiac pathologies It is important for everyone to identify the disease in time and begin treatment immediately.

It is equally important to undergo a preventive examination by a cardiologist at least once every 2 years, and from the age of 60 - every year.

The list of heart diseases is extensive, it is presented in the content. They are much easier to treat if diagnosed at an early stage. Some of them are completely curable, others are not, but in any case, if you start treatment early, you can avoid further development pathologies, complications and reduce the risk of death.

Coronary heart disease (CHD)

This is a pathology in which there is insufficient blood supply to the myocardium. The cause is atherosclerosis or thrombosis of the coronary arteries.

Classification of IHD

Acute coronary syndrome is worth talking about separately. Its symptom is a prolonged (more than 15 minutes) attack of chest pain. This term does not mean separate disease, but is used when it is impossible to distinguish myocardial infarction from symptoms based on symptoms and ECG. The patient is given a preliminary diagnosis of “acute coronary syndrome” and immediately begins thrombolytic therapy, which is needed for any acute form of coronary artery disease. Final diagnosis placed after a blood test for markers of infarction: cardiac troponin T and cardiac troponin 1. If their levels are elevated, the patient has had myocardial necrosis.

Symptoms of IHD

A sign of angina pectoris is attacks of burning, squeezing pain behind the sternum. Sometimes the pain radiates to left side, in various parts of the body: shoulder blade, shoulder, arm, neck, jaw. Less often, pain is localized in the epigastrium, so patients may think that they have problems with the stomach and not with the heart.

At stable angina attacks are triggered by physical activity. Depending on the functional class of angina (hereinafter referred to as FC), pain can be caused by stress of varying intensity.

1 FC The patient tolerates daily activities well, such as long walking, light jogging, climbing stairs, etc. Attacks of pain occur only during high-intensity exercise. physical activity: fast running, repeated lifting of weights, playing sports, etc.
2 FC An attack may occur after walking more than 0.5 km (7–8 minutes without stopping) or climbing stairs higher than 2 floors.
3 FC A person’s physical activity is significantly limited: walking 100–500 m or climbing to the 2nd floor can trigger an attack.
4 FC Attacks are triggered by even the slightest physical activity: walking less than 100 m (for example, moving around the house).

Unstable angina differs from stable angina in that attacks become more frequent, begin to appear at rest, and can last longer - 10-30 minutes.

Cardiosclerosis is manifested by chest pain, shortness of breath, fatigue, swelling, and rhythm disturbances.

According to statistics, about 30% of patients die from this heart disease within 24 hours without seeing a doctor. Therefore, carefully study all the signs of MI in order to call an ambulance in time.

Symptoms of MI

Form Signs
Anginal – the most typical Pressing, burning pain in the chest, sometimes extending into left shoulder, hand, shoulder blade, left side faces.

The pain lasts from 15 minutes (sometimes even a day). Cannot be removed by Nitroglycerin. Analgesics only weaken it temporarily.

Other symptoms: shortness of breath, arrhythmias.

Asthmatic An attack of cardiac asthma develops, caused by acute failure of the left ventricle.

Main signs: feeling of suffocation, lack of air, panic.

Additional: cyanosis of the mucous membranes and skin, accelerated heartbeat.

Arrhythmic High heart rate, low blood pressure, dizziness, possible fainting.
Abdominal Pain in the upper abdomen that radiates to the shoulder blades, nausea, vomiting. Often even doctors initially confuse it with gastrointestinal diseases.
Cerebrovascular Dizziness or fainting, vomiting, numbness in an arm or leg. By clinical picture such an MI is similar to an ischemic stroke.
Asymptomatic The intensity and duration of pain is the same as with normal pain. There may be slight shortness of breath. Distinctive feature pain - Nitroglycerin tablet does not help.

Treatment of coronary artery disease

Stable angina Relieving an attack - Nitroglycerin.

Long-term therapy: Aspirin, beta-blockers, statins, ACE inhibitors.

Unstable angina Emergency care: call an ambulance if an attack of greater intensity than usual occurs, and also give the patient an Aspirin tablet and a Nitroglycerin tablet every 5 minutes 3 times.

In the hospital, the patient will be given calcium antagonists (Verapamil, Diltiazem) and Aspirin. The latter will need to be taken on an ongoing basis.

Myocardial infarction Emergency help: call a doctor immediately, 2 tablets of Aspirin, Nitroglycerin under the tongue (up to 3 tablets with an interval of 5 minutes).

Upon arrival, doctors will immediately begin this treatment: they will inhale oxygen, administer a morphine solution, if Nitroglycerin does not relieve the pain, and administer Heparin to thin the blood.

Further treatment: pain relief with intravenous administration Nitroglycerin or narcotic analgesics; preventing further necrosis of myocardial tissue with the help of thrombolytics, nitrates and beta-blockers; constant use of Aspirin.

Blood circulation in the heart is restored using the following surgical operations: coronary angioplasty, stenting,.

Cardiosclerosis The patient is prescribed nitrates, cardiac glycosides, ACE inhibitors or beta-blockers, Aspirin, diuretics.

Chronic heart failure

This is a condition of the heart in which it is unable to fully pump blood throughout the body. The reason is heart and vascular diseases (congenital or acquired defects, ischemic heart disease, inflammation, atherosclerosis, hypertension, etc.).

In Russia, more than 5 million people suffer from CHF.

Stages of CHF and their symptoms:

  1. 1 – initial. This mild deficiency of the left ventricle, which does not lead to hemodynamic (circulatory) disturbances. There are no symptoms.
  2. Stage 2A. Poor circulation in one of the circles (usually the small circle), enlargement of the left ventricle. Signs: shortness of breath and palpitations with little physical exertion, cyanosis of the mucous membranes, dry cough, swelling of the legs.
  3. Stage 2B. Hemodynamics are impaired in both circles. The chambers of the heart undergo hypertrophy or dilatation. Signs: shortness of breath at rest, aching pain in the chest, blue tint of the mucous membranes and skin, arrhythmias, cough, cardiac asthma, swelling of the limbs, abdomen, enlarged liver.
  4. Stage 3. Severe violations blood circulation Irreversible changes in the heart, lungs, blood vessels, kidneys. All signs characteristic of stage 2B intensify, and symptoms of damage appear internal organs. Treatment is no longer effective.

Treatment

First of all, treatment of the underlying disease is necessary.

Symptomatic drug treatment is also carried out. The patient is prescribed:

  • ACE inhibitors, beta blockers or aldosterone antagonists - to lower blood pressure and prevent further progression of heart disease.
  • Diuretics - to eliminate edema.
  • Cardiac glycosides - for the treatment of arrhythmias and improvement of myocardial performance.

Valve defects

There are two typical types of valve pathologies: stenosis and insufficiency. With stenosis, the valve lumen is narrowed, making it difficult to pump blood. In case of insufficiency, the valve, on the contrary, does not close completely, which leads to the outflow of blood in the opposite direction.

More often, such heart valve defects are acquired. They appear against the background of chronic diseases (for example, ischemic heart disease), previous inflammation or poor lifestyle.

The aortic and mitral valves are most susceptible to disease.

Symptoms and treatment of the most common valve diseases:

Name Symptoms Treatment
Aortic stenosis At the initial stage there are no signs, so it is very important to undergo regular preventive examination hearts.

At a severe stage, attacks of angina pectoris, fainting during physical exertion, pale skin, and low systolic blood pressure appear.

Drug treatment of symptoms (due to valve defects). Valve replacement.
Failure aortic valve Increased heart rate, shortness of breath, cardiac asthma (attacks of suffocation), fainting, low diastolic blood pressure.
Mitral stenosis Shortness of breath, enlarged liver, swelling of the abdomen and limbs, sometimes - hoarseness of voice, rarely (in 10% of cases) - pain in the heart.
Mitral valve insufficiency Shortness of breath, dry cough, cardiac asthma, swelling of the legs, pain in the right hypochondrium, It's a dull pain in the heart.

Mitral valve prolapse

Another common pathology is. Occurs in 2.4% of the population. This is a congenital defect in which the valve leaflets “sink” into the left atrium. In 30% of cases it is asymptomatic. In the remaining 70% of patients, doctors note shortness of breath, pain in the heart area, accompanied by nausea and a feeling of a “lump” in the throat, arrhythmias, fatigue, dizziness, and frequent increases in temperature to 37.2–37.4.

Treatment may not be required if the disease is asymptomatic. If the defect is accompanied by arrhythmias or pain in the heart, prescribe symptomatic therapy. If the valve changes significantly, surgical correction is possible. Since the disease progresses with age, patients need to be examined by a cardiologist 1-2 times a year.

Ebstein's anomaly

Ebstein's anomaly is a displacement of the tricuspid valve leaflets into the right ventricle. Symptoms: shortness of breath, paroxysmal tachycardia, fainting, swelling of the veins in the neck, enlargement of the right atrium and the upper part of the right ventricle.

Treatment for asymptomatic cases is not carried out. If signs are pronounced, do surgical correction or valve transplantation.

Congenital heart defects

TO congenital anomalies structures of the heart include:

  • Defect interatrial septum– presence of communication between the right and left atria.
  • Defect interventricular septum– pathological communication between the right and left ventricles.
  • The Eisenmenger complex is a high-lying ventricular septal defect, the aorta is displaced to the right and connects simultaneously with both ventricles (aortic dextroposition).
  • Patent ductus arteriosus - the communication between the aorta and the pulmonary artery, which is normally present at the embryonic stage of development, is not closed.
  • Tetralogy of Fallot is a combination of four defects: ventricular septal defect, aortic dextroposition, pulmonary stenosis and right ventricular hypertrophy.

Congenital heart defects - signs and treatment:

Name Symptoms Treatment
Atrial septal defect With a small defect, signs begin to appear in middle age: after 40 years. This is shortness of breath, weakness, fatigue. Over time, chronic heart failure develops with all the characteristic symptoms. How larger sizes defect, the sooner symptoms begin to appear. Surgical closure of the defect. Doesn't always happen. Indications: ineffective drug treatment CHF, lag in physical development in children and adolescents, increased blood pressure in the pulmonary circle, arteriovenous discharge. Contraindications: venoarterial shunt, severe left ventricular failure.
Ventricular septal defect If the defect is less than 1 cm in diameter (or less than half the diameter of the aortic orifice), only shortness of breath is characteristic during moderate-intensity physical activity.

If the defect is larger than the specified size: shortness of breath with light exertion or at rest, heart pain, cough.

Surgical closure of the defect.
Eisenmenger complex Clinical picture: bluish skin, shortness of breath, hemoptysis, signs of CHF. Medication: beta-blockers, endothelin antagonists. Surgery to close the septal defect, correct the aortic origin, and replace the aortic valve is possible, but patients often die during the procedure. Average duration The patient's life is 30 years.
Tetralogy of Fallot Blue tint of mucous membranes and skin, retarded growth and development (both physical and intellectual), seizures, low blood pressure, symptoms of heart failure.

Average life expectancy is 12–15 years. 50% of patients die before the age of 3 years.

Surgical treatment is indicated for all patients without exception.

IN early childhood perform an operation to create an anastomosis between the subclavian and pulmonary arteries to improve blood circulation in the lungs.

At 3–7 years old it is possible to carry out radical surgery: simultaneous correction of all 4 anomalies.

Patent ductus arteriosus A long time passes without clinical signs. Over time, shortness of breath and palpitations, pallor or a blue tint to the skin, and low diastolic blood pressure appear. Surgical closure of the defect. Indicated for all patients, with the exception of those who have a right-to-left shunt.

Inflammatory diseases

Classification:

  1. Endocarditis – affects the inner lining of the heart, the valves.
  2. Myocarditis – muscle membrane.
  3. Pericarditis - the pericardial sac.

They can be caused by microorganisms (bacteria, viruses, fungi), autoimmune processes (for example, rheumatism) or toxic substances.

Heart inflammation can also be complications of other diseases:

  • tuberculosis (endocarditis, pericarditis);
  • syphilis (endocarditis);
  • flu, sore throat (myocarditis).

Pay attention to this and consult a doctor promptly if you suspect flu or sore throat.

Symptoms and treatment of inflammation

Name Symptoms Treatment
Endocarditis High temperature (38.5–39.5), increased sweating, rapidly developing valve defects (detected by echocardiography), heart murmurs, enlarged liver and spleen, increased fragility blood vessels (you may notice hemorrhages under the nails and in the eyes), thickening of the fingertips. Antibacterial therapy for 4–6 weeks, valve transplantation.
Myocarditis It can occur in several ways: attacks of pain in the heart; symptoms of heart failure; or with extrasystole and supraventricular arrhythmias. An accurate diagnosis can be made based on a blood test for cardiac-specific enzymes, troponins, and leukocytes. Bed rest, diet (No. 10 with salt restriction), antibacterial and anti-inflammatory therapy, symptomatic treatment heart failure or arrhythmias.
Pericarditis Chest pain, shortness of breath, palpitations, weakness, cough without phlegm, heaviness in the right hypochondrium. Non-steroidal anti-inflammatory drugs, antibiotics, in severe cases - subtotal or total pericardiectomy (removal of part or all of the pericardial sac).

Rhythm disorders

Reasons: neuroses, obesity, unhealthy diet, cervical osteochondrosis, bad habits, intoxication with drugs, alcohol or drugs, ischemic heart disease, cardiomyopathy, heart failure, premature ventricular excitation syndromes. The latter are heart diseases in which there are additional impulse pathways between the atria and ventricles. You will read about these anomalies in a separate table.

Characteristics of rhythm disturbances:

Name Description
Sinus tachycardia Rapid heart rate (90–180 per minute) when persistent normal rhythm and the normal pattern of impulse propagation throughout the heart.
Atrial fibrillation (flicker) Uncontrolled, irregular and frequent (200–700 per minute) atrial contractions.
Atrial flutter Rhythmic contractions of the atria with a frequency of about 300 per minute.
Ventricular fibrillation Chaotic, frequent (200–300 per minute) and incomplete ventricular contractions.
The absence of a complete reduction provokes acute failure blood circulation and fainting.
Ventricular flutter Rhythmic contractions of the ventricles with a frequency of 120–240 per minute.
Paroxysmal supraventricular (supraventricular) tachycardia Attacks of rhythmic rapid heartbeat (100–250 per minute)
Extrasystole Spontaneous contractions out of rhythm.
Conduction disorders (sinoatrial block, interatrial block, atrioventricular block, bundle branch block) Slowing down the rhythm of the entire heart or individual chambers.

Syndromes of premature excitation of the ventricles:

WPW syndrome (Wolf–Parkinson–White syndrome) CLC syndrome (Clerc-Levy-Christesco)
Signs: paroxysmal (paroxysmal) supraventricular or ventricular tachycardia(in 67% of patients). Accompanied by a feeling of increased heartbeat, dizziness, and sometimes fainting. Symptoms: tendency to attacks of supraventricular tachycardia. During them, the patient feels a strong heartbeat and may feel dizzy.
Cause: the presence of a bundle of Kent, an abnormal pathway between the atrium and ventricle. Cause: presence of a James bundle between the atrium and the atrioventricular junction.
Both diseases are congenital and quite rare.

Treatment of rhythm disturbances

It consists of treating the underlying disease, adjusting diet and lifestyle. Also prescribed antiarrhythmic drugs. Radical treatment for severe arrhythmias is the installation of a defibrillator-cardioverter, which will “set” the rhythm of the heart and prevent ventricular or atrial fibrillation. In case of conduction disturbances, electrical cardiac stimulation is possible.

Treatment of premature ventricular excitation syndromes can be symptomatic (elimination of attacks with medications) or radical (radiofrequency ablation of the abnormal conduction pathway).

Cardiomyopathies

These are myocardial diseases that cause heart failure, not associated with inflammatory processes or pathologies of the coronary arteries.

The most common are hypertrophic and. Hypertrophic is characterized by the growth of the walls of the left ventricle and the interventricular septum, dilated - by an increase in the cavity of the left and sometimes right ventricles. The first is diagnosed in 0.2% of the population. Occurs in athletes and can cause sudden cardiac death. But in this case it is necessary to carry out a thorough differential diagnosis between hypertrophic cardiomyopathy and non-pathological enlargement of the heart in athletes.

The number of people with heart and vascular diseases is rapidly increasing every year, many of them are getting younger. However, most of these diseases do not have any noticeable symptoms in the initial stages, so they are often paid attention to only when they become chronic or lead to other, more serious pathologies.

Most heart and vascular diseases are reversible if you pay attention to your condition and lifestyle in time. Often these diseases and their development depend solely on the person, hereditary factor And concomitant diseases don't have that much of an impact.

Heart disease

Heart disease is becoming an increasingly common cause fatal outcome or the occurrence of severe complications. In addition to congenital diseases, there are often those that develop as complications of other diseases or due to poor lifestyle choices.

One of the most common diseases is tachycardia, rapid heartbeat. It is being diagnosed more and more often, due to the excessively fast pace modern life contributing to stress, poor nutrition, bad habits, an uncomfortable mode of work and rest for a person.

Reasons

Some of the diseases are congenital, for example, heart disease, and unfavorable heredity also plays a role. However, there are other, often more significant factors in the development of heart disease.

  1. Viral or bacterial infections. Lead to various inflammatory diseases of the heart muscle: endocarditis, periocarditis, myocarditis, which can lead to irreversible damage to the heart.
  2. Frequent stress. Constant tension and negative emotions also have a bad effect on the functioning of the heart muscle; they often lead to tachycardia and other rhythm disturbances.
  3. Poor nutrition, excess cholesterol. Promote the development of atherosclerosis.
  4. Abuse of alcohol, tobacco, coffee and other tonic substances and drinks.
  5. Lack of physical activity, irrational and inappropriate physical activity for health reasons.

Important! Most factors in the development of heart disease can be influenced if you take good care of your health and lifestyle.

Symptoms

The symptoms of all heart diseases are similar, the main problem is that they are often attributed to fatigue or general malaise, without even realizing that they are talking about serious problems. If at least some of them are present, this is a reason to consult a specialist - a therapist or cardiologist.

  1. The appearance of shortness of breath after any physical activity, even weak. Sometimes shortness of breath can occur even when you are calm.
  2. The appearance of severe weakness, sometimes or constantly.
  3. Dry cough, usually at night.
  4. Pain and discomfort in the heart area can radiate to the back or liver area.
  5. The pulse is too frequent or rare; it can change for no apparent reason.
  6. Swelling of the legs, appearing in the evening.
  7. Difficulty breathing, especially at night.

Important! These symptoms should be a reason to consult a doctor.

With development heart disease symptoms become more intense, new ones are added. It is important to notice their presence in time and contact a specialist, he will help make the correct diagnosis and prescribe treatment. Therapy for heart disease is rarely simple; you usually have to change your lifestyle almost completely in order to prevent a relapse or develop a more serious pathology.

Some diseases of the cardiovascular system lead to stroke, an acute circulatory disorder in the brain caused by blockage of a blood vessel with a blood clot or plaque. Stroke is also sometimes classified as a disease of the heart and blood vessels, but this problem is considered by neurologists, although it occurs due to disturbances in the functioning of the cardiovascular system.

If you do not pay proper attention to the problem, it can lead to a heart attack and other life- and health-threatening consequences. Heart disease should always be taken with due seriousness. Persons with heart failure should always be under the supervision of a specialist, as the disease can worsen without proper treatment.

Vascular diseases are worth mentioning separately. The most common is atherosclerosis, in which plaques form inside the vessels due to high content cholesterol, varicose veins and thrombophlebitis, when inflammation and thrombosis of the vein occurs.

Atherosclerosis

Atherosclerosis – chronic disease, in which the lumen of the vessel decreases, which means that normal blood circulation becomes difficult. Most often, this disease occurs in older people, although experts note that in lately it looks a little younger.

The main causes of atherosclerosis are unhealthy diet, frequent stress, diseases of the gastrointestinal tract. Most often, men over 35 years of age, who are especially susceptible to frequent unrest, become ill.

Atherosclerosis does not manifest itself for a long time, only then shortness of breath, constant weakness, and loss of ability to work appear. Therefore, in order to identify this problem at an early stage, preventive examinations by a cardiologist should not be neglected, especially after 35-40 years. Once the disease is diagnosed, you may have to completely change your lifestyle.

Important! Atherosclerosis can lead to stroke.

Varicose veins

With varicose veins, the veins of the lower extremities expand and lengthen, which causes the appearance of vascular “stars” and “nodules” on the legs. Many people believe that varicose veins are just a cosmetic defect, but this opinion is wrong. Varicose veins are a full-fledged disease that requires attention.

The main causes of varicose veins are: overweight bodies and activities that require a lot of standing. Varicose veins occur more often in women, and heredity can also play a role.

Varicose veins initially manifest themselves as swelling of the legs, only then “stars” and bulging veins begin to form. Also often present muscle cramps in the legs. If varicose veins start to develop, eczema and non-healing ulcers may appear at the sites of bulging vessels.

On at the moment There are many effective methods that allow you to get rid of varicose veins forever or significantly alleviate its course. This disease cannot be ignored.

Thrombophlebitis

With thrombophlebitis, the vein becomes blocked by a blood clot and becomes inflamed. Most often, this disease affects the veins of the lower extremities, but there are also thromboses of the veins of the neck, arms and chest.

The main causes of thrombophlebitis include various mechanical injuries of the vessel, complications varicose veins, other inflammatory diseases and infections. There is also a hereditary predisposition.

With thrombophlebitis, swelling, redness and induration occur on the skin at the sites where the blood clot occurs, darkening of the skin, in place of which a blood clot may form. trophic ulcer and sharp pains. If such symptoms appear, you should consult a doctor as soon as possible.

Diseases of the heart and blood vessels are quite serious and require attention in all cases. It is impossible to cope with them without the help of a specialist; if they are started, this can lead to extremely serious consequences.

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