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Cardiovascular disease is the main cause of invalidism and premature death in economically developed countries. In the early 1970’s, 40 to 60 percent of all deaths were attributed to cardiovascular disease. This form of disease has become a serious sociomedical problem: morbidity has unquestionably risen, and increasingly younger ages have become affected. The prevalence rate of cardiovascular disease has increased with the average life expectancy (and accordingly, an older and older population) and with advances in diagnosis. Modern methods of diagnosis include electrocardiography, phonocardiography, angiocardiography, cardiac catheterization, and numerous new biochemical techniques. It has been established that urbanization has led to an increase in cardiovascular disease. As a result of urbanization, modern man is subjected to a great deal of tension, and his eating habits have become irregular.
Cardiovascular disease can affect the heart, the vessels of coronary circulation, the arteries, and the veins. Myocardial ischemia is a deficiency of blood supply to cardiac muscle. It is the major cause of death attributed to cardiovascular desease, and, consequently, it is one of the chief problems confronting medicine. Myocardial ischemia is brought about by atherosclerotic damage, spasms, and thrombosis of the coronary arteries. Its clinical forms include angina pectoris, myocardial infarction, and atherosclerotic cardiosclerosis. More frequently encountered today are myocarditis, an inflammatory myocardial disease, and cardiomyopathy, a noninflammatory myocardial disease.
Endocarditis, an infectious and inflammatory disease of the endocardium, is the main cause of rheumatic carditis and other acquired heart diseases. Advances in the treatment of rheumatic fever and highly effective antibacterial techniques have reduced the occurrence of acquired heart disease, although congenital heart disease occurs more frequently. Pericarditis, an inflammation of the pericardium, occurs less frequently. Myocardial ischemia, myocarditis, cardiomyopathy, and nervous conditions may disrupt conduction or the rhythm of heart contraction (arrhythmia). Nervous disorders of the heart during neuroses are manifested by arrhythmia and protracted aching, pricking, or stabbing pains in the area of the heart that are unrelated to physical exertion.
The most widespread arterial disease, atherosclerosis, affects the coronary arteries. It often also affects the aorta and its main branches, including the renal arteries (resulting in increased arterial pressure), the brain vessels and the peripheral vessels of the extremities. Severe complications of atherosclerosis known as cerebrovascular accidents can develop in the brain vessels. When the peripheral vessels of the extremities are involved, symptoms include periodic weakness, numbness in an arm or leg, and intermittent claudication. Another widespread vascular disease is hypertension, which, like atherosclerosis, is closely linked to modern man’s lifestyle. Hypertension and atherosclerosis occur together, and the course of each disease is consequently affected.
Arteritis is the inflammation of an artery; it may result from infectious diseases (syphilis, sepis), allergic diseases (serum sickness), or collagen diseases. The inflammatory process may affect either the internal, middle, or external vascular layer or all three layers (panarteritis). Arteritis is often complicated by thrombosis; this condition is known as thromboarteritis. The clinical manifestations of arteritis include endarteritis obliterans and syphilitic aortitis. Another manifestation is panarteritis of the aorta and its outgoing branches, which is called pulseless disease or Takayasu’s disease. Raynaud’s phenomenon is a vascular condition, characterized by spasmodic contractions of the small arteries of the arms and legs. The most frequent venous diseases are varicose veins and thrombophlebitis.
Many cardiovascular diseases lead to circulatory insufficiency, which results from a reduction in the contractility of cardiac muscle and the contractile power of the muscle layer in the walls of peripheral vessels. Each of these factors may be the initial factor in the disease, which determines whether the disease is acute or chronic heart failure or vascular insufficiency. Vascular insufficiency, or hypotonia, also occurs in acute and chronic forms. The acute form is characterized by syncope, collapse, and shock. The chronic form may be marked by repeated symptoms of acute vascular insufficiency or by constantly low arterial pressure, weakness, vertigo, and headache.
The primary advances in the treatment of cardiovascular disease involve the use of effective agents that reduce high arterial pressure and new surgical procedures to treat acquired and congenital heart disease. There are a number of new methods for treating myocardial infarction and circulatory insufficiency. A particularly notable advance is the use of artificial cardiac pacemakers.
Cardiology is the specialized scientific discipline concerned with the study of cardiovascular disease.
REFERENCESLang, G. F. Boleznisistemy krovoobrashcheniia, 2nd ed. Moscow, 1958.
Jonas, V. Chastnaia kardiologiia, vols. 1–2. Prague, 1960–63. (Translated from Czech.)
N. R. PALEEV