2023-04-25 12:07:38
Cardiovascular diseases are among the greatest health challenges worldwide, they are considered modern widespread diseases caused by an unfavorable lifestyle. Studies on Egyptian mummies have shown, however, that people suffered from arteriosclerosis 3,500 years ago, meaning their arteries were clogged with deposits that can lead to heart attacks or strokes, among other things. Perhaps those affected were advised by their doctor to drink less millet beer and to take a walk around the pyramid from time to time. Because research assumes that the Egyptians tended to be mummified – and even then they possibly had a lifestyle that promoted vascular calcification. It is true that factors that cannot be influenced can also promote cardiovascular diseases, such as lipid metabolism diseases or inflammation of the heart muscle caused by viruses. However, no one denies that external factors such as smoking, obesity or lack of exercise are among the decisive risk factors. Experts are therefore always calling for increased efforts in prevention – and more money for further research into the causes and treatment options for cardiovascular diseases.
From soul seat to blood circulation
Due to its wide range, cardiology is already one of the most intensively researched areas of medicine, and not just since yesterday. People have always thought about the function of the heart and blood vessels, described diagnostic and therapeutic approaches and also relied on technical progress – in our days, for example, digitalization. What would Aristotle have said about a modern cardiology ward? He believed that the heart is the seat of the soul and that its contractions affect our emotions. Galen, on the other hand, one of the most famous physicians of antiquity, who died in Rome around 200 AD, was aware of the function of the heart in distributing blood and supplying oxygen, but in his opinion the blood was “used up” in the body.
The English doctor and anatomist William Harvey (1578 – 1657) was the first to recognize that blood circulates in a closed circulatory system and that veins and arteries are connected to one another. His Anatomical Treatise on the Movements of the Heart and Blood in Animals, first published in 1628, is considered a milestone in the history of medicine and cardiology. Also in the 17th century, the first instruments for measuring blood pressure were developed, which represented an important basis for the further development of cardiology. The 18th century saw auscultation, i.e. listening to heart sounds with a stethoscope, as a diagnostic procedure. Measuring blood pressure using a cuff was developed at the turn of the 19th and 20th centuries.
Rapid development
In the 20th century, progress became ever more rapid. In 1903, the Dutchman Willem Einthoven invented the ECG technique. In 1929, the German Werner Forssmann pushed a catheter through his arm vein into the right atrium. Together with others, he created the basis for the diagnostic and later therapeutic use of catheters. Artificial heart valves, for example, are now used with their help. The introduction of echocardiography in the 1950s made it possible to visualize the heart and its functions for the first time. Coronary angiography was developed in the 1960s. It allows narrowing and occlusion of the coronary arteries to be diagnosed and treated in a targeted manner. The first pacemaker was implanted in 1958 and the first artificial heart valve in 1961. In 1967, a bypass was laid and a heart was transplanted for the first time. In the 1970s, balloon dilatation was introduced, in which narrowed coronary arteries can be widened with the help of a balloon. Stents have been used since the late 1980s. Medications such as beta-blockers, ACE inhibitors, and statins (cholesterol-lowering drugs) were developed between the 1960s and the late 1980s. With an artificial heart, doctors at the German Heart Center Berlin successfully bridged the waiting time for a transplant for the first time in 1990.
»Telemonitoring is one of the most important trends in the digitization of cardiology.«
Finally, heart medication saves millions of lives every year. The British pharmacologist James Black developed the first beta blocker in 1964. Beta blockers reduce the resting heart rate and thus blood pressure and are used to treat high blood pressure and coronary heart disease. The discovery of the mechanisms of action of beta blockers is considered one of the greatest achievements of medicine in the 20th century. Since the 1980s, ACE inhibitors have also been used to treat high blood pressure and heart failure, as have statins, which lower blood cholesterol levels and thus reduce the risk of atherosclerosis. Beta blockers, ACE inhibitors and statins are among the most commonly prescribed drugs worldwide.
Digitalization trend
In recent years, digitization has also found its way into cardiology. Modern imaging methods such as magnetic resonance imaging (MRT) or computed tomography (CT) make it possible to show the heart and its functions in great detail. With 3D imaging, doctors can view the heart from different angles and make more accurate diagnoses. Robots are used to support diagnostic or therapeutic interventions, such as when performing catheter ablation for cardiac arrhythmias, i.e. a targeted obliteration of excitation lines in the heart. The robot allows for greater precision and accuracy in catheter placement. The robot does not carry out the intervention itself – rather, extremely precise electro-mechanical instruments are involved, which are controlled by the operator.
Telemonitoring is one of the most important trends in the digitization of cardiology. Patients with heart failure or other heart diseases are monitored here, even when they are not in the hospital. For example, with the help of an implant that is only a centimeter long, which is pushed under the skin over the chest muscle. The implant records the heart’s function and sends its data to the treating clinic at night via a small transmitter station next to the bed. Special software evaluates the data. If she recognizes unusual patterns, she reports this to the doctor. They then get in touch with those affected. Such telemonitoring solutions can help to prevent strokes, for example. The risk of a stroke increases in people with a special form of cardiac arrhythmia, atrial fibrillation. It is often not discovered in a one-off ECG performed in the clinic. Long-term observation through telemonitoring solves this problem. Heart rate and other parameters can also be monitored with wearables, portable devices such as smartwatches or fitness trackers. Some of these devices are able to create EKG recordings and send them to the doctor. Finally, AI technologies can help analyze large amounts of data faster and more accurately. In cardiology, AI algorithms can help improve the diagnosis of heart disease and optimize the choice of therapy by evaluating data from imaging processes or telemonitoring.
“Genetic tests can help to assess the individual risk of cardiovascular disease.”
Ultimately, personalization is also gaining in importance in cardiac medicine. Genetic tests, for example, can help to assess the risk of cardiovascular disease and to find the best therapeutic approach. The imaging procedures mentioned, which are becoming more and more precise, help to record the individual status of patients and, for example, to prepare and accompany any operations even better. Medicine also has hopes for stem cell therapy, in which the body’s own stem cells are used to repair damaged heart tissue.
From the ancient Egyptians to modern medicine: the heart and circulatory system will occupy doctors as long as there are people. And every year, the possibilities for treating and curing cardiovascular diseases are growing.
COMMON CARDIOVASCULAR DISEASES
KORONARE HERZKRANKHEIT (KHK)
In CHD, the coronary arteries, which supply the heart itself with blood and, above all, oxygen, are narrowed as a result of vascular deposits. The resulting lack of oxygen can damage the heart muscle and weaken the heart. In addition, blood clots can form more easily, which completely block an artery – resulting in a heart attack.
HIGH BLOOD PRESSURE
Medicine sees several interacting factors for high blood pressure, including obesity, smoking, lack of exercise, but also genetic predisposition. Persistently high blood pressure leads to hardening and narrowing of the blood vessels. This reduces the supply of oxygen to the heart, brain, kidneys and other organs. High blood pressure is a risk factor for heart attacks and strokes.
HEART FAILURE
Heart failure describes a weakening of the pumping function of the heart, which can no longer supply the body with sufficient oxygen. The most common causes are high blood pressure, coronary artery disease and the consequences of a heart attack. Over time, the pumping capacity decreases more and more, and if left untreated, heart failure can lead to death. In addition, due to various compensation mechanisms, more fluid accumulates in the body (“water in the legs”).
HEART RHYTHM DISORDERS
In the case of cardiac arrhythmias, the course of cardiac muscle excitation is disturbed. The heart beats too slowly, too fast, or irregularly. The disorders can be the result of a variety of heart diseases, including CHD or high blood pressure, but risk factors are also, for example, diabetes, old age, drug or
alcohol abuse. The so-called atrial fibrillation, which increases the risk of a stroke, is feared.
HEART VALVE DISEASES
In the case of heart valve disease, the heart valves, which act as a “valve” between the atria and the ventricles, are either narrowed or no longer close properly. This disrupts the normal blood flow in the heart and can lead to heart failure. Causes include age-related calcification of the heart valves.
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