Cardiology

Atherosclerosis is a chronic inflammatory disease of the blood vessels that results from the accumulation of lipids and fibrosis of the arterial wall. This process causes the arterial wall to become thicker, stiffer and harder. The disease affects large and medium-sized arteries throughout the body, particularly those of the heart (coronary arteries), brain (carotid arteries) and legs (peripheral arteries).

The main characteristic of atherosclerosis is the narrowing of an artery due to the build-up of plaque on its inner walls. When this narrowing obstructs blood flow in an artery, it can lead to angina or a heart attack. At a later stage, atherosclerosis can cause peripheral arterial disease, which can lead to gangrene if not treated properly.

Symptoms of atherosclerosis include:

• Tiredness
• Dizziness
• Chest pain
• Leg pain
• Shortness of breath

Lymphoedema (treated in our cardiology department) is a condition that causes swelling of the limbs and other parts of the body. Swelling occurs when lymphatic vessels are damaged or blocked, preventing the body from draining excess fluid.

Lymph vessels are part of the immune system that helps fight infections and diseases. They also collect fluid that returns to the heart, lungs and other organs after passing through tissues such as the skin, nose and mouth. If these vessels are blocked or damaged, they cannot properly drain the fluid they collect into larger veins. This extra fluid accumulates in the affected area and causes swelling.

Swelling caused by lymphatic involvement can be painless or painful, depending on where in the body it occurs. It can also cause itching, redness and heat in the affected area. If you have significant swelling for a long time, it can lead to skin changes such as thickening (papular lymphoedema) or discolouration (late lymphoedema).

There are two types of lymphoedema: primary and secondary.

• Primary lymphoedema occurs when something goes wrong with the lymphatic system itself, such as congenital anomalies (present at birth) or tumours that affect the lymph nodes.
• Secondary lymphoedema occurs when something blocks the flow of lymph fluid through damaged or diseased tissue. This type of lymphoedema most commonly occurs after surgery for breast cancer or some other types of cancer, but it can also occur after surgery to remove an infection from the appendix, gallbladder or tonsils, or after other conditions affecting internal organs.

Treating lymphedema:

If you suspect you have lymphoedema, see your doctor immediately for a diagnosis and treatment options. Lymphoedema should be treated by a doctor who specialises in treating this condition. Your doctor will probably recommend a combination of treatments, including compression bandages and exercises to increase lymph circulation throughout the body.

Compression bandages are usually worn for several weeks until they no longer provide adequate support for your limb(s). At this point, you will be reassessed to determine if additional compression bandages are needed or if custom-made stockings should be used instead.

Dyspnoea is a medical term used to describe shortness of breath. It is an uncomfortable sensation of difficulty breathing that can be associated with physical exertion or even rest.

Dyspnoea can be experienced as chest tightness, difficulty breathing in (inspiratory dyspnoea) or out (expiratory dyspnoea). This is not the same as breathlessness caused by anxiety or panic attacks, which have no physical basis.

Breathing in or out against a closed airway creates resistance to airflow and causes dyspnoea. This occurs in asthmatics who suffer from bronchospasm (narrowing of the airways), but also in patients without respiratory disease who are undergoing surgery in the chest cavity, such as open heart surgery.

Bouveret’s disease is a rare genetic disorder that causes nerve damage in the eye. It is also known as optical atrophy or Progressive external ophthalmoplegia (PEO).

It is caused by a mutation in one of two genes:

BOUVET1, located on chromosome 10q11; and

BOUVET2, located on chromosome 2q33-34.

These genes provide instructions for making proteins called light myosin chains, which are important for muscle function. Mutations affect the ability of light myosin chains to attach to other proteins and form functional muscles. As a result, affected people have reduced muscle strength and weakness in the arms and legs (peripheral neuropathy). They may also have problems with balance and coordination (ataxia), which can affect their ability to walk normally.

In addition to muscle weakness, people with Bouveret’s disease have vision problems that get worse over time. The first symptoms usually appear between the ages of 20 and 40, usually during puberty or early adulthood, but can occur at any age thereafter.

Stenosis is the medical term for the narrowing or constriction of a channel, duct or light. Stenosis can be caused by degenerative diseases such as osteoarthritis and rheumatoid arthritis. In the heart, stenosis refers to a narrowing of the arteries that supply blood to the heart muscle. This can be caused by the build-up of plaque in the arteries (atherosclerosis), which reduces their diameter.

Stenosis can also occur in other vessels leading from the heart, such as the coronary arteries and aorta, and in heart valves. Symptoms include pain, numbness and weakness in the lower back, legs and arms. The pain can be sudden or gradual and can vary in intensity from mild to severe.

Stenosis can be caused by degenerative disc disease or spinal stenosis (also called spinal canal stenosis). Degenerative disc disease occurs when the discs between the vertebrae become thinner and less flexible over time, leading to swelling and herniation of the disc material through the spaces between the bones (vertebral foramina). This herniation puts pressure on the nerves that transmit sensation to the body. Spinal stenosis occurs when the bones of the spine collapse (osteophytes) or move closer together (spondylolisthesis), narrowing the opening of the spinal canal.

Treatment depends on the cause of the stenosis, but may include medications such as steroids or anti-inflammatories, physiotherapy, and surgery to remove damaged bones or clear narrowed spaces in the spine.

Angina pectoris, also known as angina, is a type of chest pain or discomfort that occurs when the heart is not getting enough blood and oxygen. Angina pectoris (treated in our cardiology department) can sometimes be a warning sign of a heart attack.

Angina occurs when the heart muscle needs more oxygen-rich blood than it can get from the coronary arteries. These are the arteries that supply blood to the heart muscle. If they are narrowed or blocked, they cannot supply enough blood to meet the heart muscle’s needs. This causes the symptoms of angina.

There are two main types of angina: stable angina and unstable angina.

Stable angina occurs at rest or during physical activity that does not put significant stress on the heart, and can occur even when the heart is beating normally (normal heart rate). Stable angina may get better with rest, but usually gets worse with physical activity that increases the heart rate or breathing rate (ventilation).

Unstable angina occurs suddenly and severely when the heart needs more oxygen-rich blood than it can get through narrowed or blocked coronary arteries. Unstable angina can occur at rest or during exercise.