CARDIOVASCULAR RISK FACTORS
1/ Age and sex: cardiovascular accidents occur on average 10 years earlier in men than in women; before the age of 65, cardiovascular mortality is 4 times higher than in women.
2/ Cardiovascular heredity: this is assessed on the basis of cardiovascular events in first-degree relatives aged < 55 in men and < 65 in women. In practice, it is often environmental factors (smoking, poor diet, sedentary lifestyle, etc) rather than genetics that explain events over several generations.
3/ Tobacco: the leading cause of avoidable death. A quarter of all deaths are cardiovascular. The risk of heart attack is proportional to consumption, but there is no threshold level of consumption below which there is no risk.
4/ Hypertension: persistent elevation of blood pressure, whatever the cause, affecting almost 30% of French adults. It has been called the silent killer because it generally causes no symptoms for many years, until a vital organ is damaged. If left unchecked, high blood pressure increases the risk of stroke (the leading cause), aneurysm, heart failure, heart attack and chronic kidney disease.
5/ Hypercholesterolaemia: the most important risk factor for coronary heart disease.
6/ Diabetes: affects 5% of the population. It is the cause of microvascular complications (retinopathy, nephropathy, neuropathy) and macrovascular complications (coronary heart disease, stroke, peripheral arterial disease).
7/ Sedentary lifestyle, overweight and obesity: metabolic syndrome
The sedentary Western lifestyle is at the root of an energy imbalance between calorie intake and expenditure. Around 20 million French people are overweight, 6 million of whom are obese. This phenomenon also affects children and adolescents. This sedentary lifestyle and overweight have a major influence on the early onset and extent of metabolic disorders in young and middle-aged adults (diabetes, hypertension, hyperlipidaemia, etc.) and the risk of cardiovascular events.
GOOD TO KNOW: Risk factors do not add up, they potentiate, i.e. they make each other worse. Thus, the combination of several risk factors, even of low intensity, can lead to a very high risk of cardiovascular disease. For example, if you have moderate blood pressure, a slight intolerance to sugar, moderately high cholesterol and are a light smoker, you are much more 'at risk' than someone with very high cholesterol on their own.
Source: French Society of Cardiology
The diagnosis must most often be made quickly to avoid serious complications and to allow the necessary treatments, most often medicinal, to be started as early as possible, under cardiological supervision by experienced doctors.
Sometimes interventional procedures are necessary and are carried out by a dedicated team of interventional cardiologists (rhythmologist and coronary angiographer). These different pathologies are revealed by very varied symptoms leading the patient to consult or be hospitalized.
Cardiovascular diseases
1/ Cardiomyopathies :
• Ischaemic: weakening of cardiac function following an infarction
• Dilated: dilation of the heart muscle. Causes: genetic, viral, autoimmune, alcohol/toxicity.
• Hypertrophic: abnormal thickening of the heart muscle. Causes: genetic, hypertension, metabolic, pathologies of overload (amyloidosis, Fabry disease).
2/ Valvulopathies :
• Aortic stenosis: obstacle to the ejection of blood to the aorta and the rest of the body due to abnormal narrowing of the aortic valve. Causes: age, congenital malformation
• Aortic insufficiency: abnormal leakage of blood through the aortic valve. Causes: aortic dilatation, congenital malformation.
• Mitral stenosis: stenosis of the mitral orifice obstructing blood flow from the left atrium to the left ventricle. Cause: rheumatic fever (=acute inflammatory complication of a group A streptococcal throat infection).
• Mitral insufficiency: abnormal leakage of blood through the mitral valve. Causes: infectious endocarditis, infarction, congenital malformation, thoracic trauma, etc.
3/ Heart rhythm disorders :
• Atrial fibrillation: anarchic and rapid electrical activity of the atria, resulting in their disordered and ineffective contraction. Intra-atrial thrombi (clots) can form, leading to a significant risk of thrombo-embolic stroke.
• Junctional tachycardia: linked to an electrical short-circuit at the junction between the atria and the ventricles, this is one of the main causes of palpitations with a sudden start and end in a healthy heart.
• Ventricular tachycardia: tachycardia originating directly from the ventricles, requiring rapid assessment to determine the cause and treatment.
4/ Cardiac conduction disorders :
• Branch blocks: blockage of conduction resulting in partial or complete interruption of the flow of electrical impulses through the right or left branches.
• Atrioventricular block: delay in the conduction of the electrical current as it passes through the atrioventricular conduction system. There are several types, with different origins and severity.
5/ Infectious/inflammatory diseases :
• Acute pericarditis: sudden inflammation of the pericardium (covering around the heart), often painful, causing an effusion of fluid. Causes: viral, bacterial or fungal, autoimmune diseases, thoracic trauma, cancer, allergic reactions or side effects of certain drugs.
• Myocarditis: inflammation of the heart muscle that can lead to tissue death. Causes: viral, bacterial, fungal or parasitic, although the exact cause is often not identified.
• Infective endocarditis: infection of the inner lining of the heart (endocardium) and usually also of the heart valves.
6/ Thrombo-embolic diseases:
• Deep vein thrombosis/phlebitis: inflammation of a vein accompanied by the formation of a clot inside it. Causes: prolonged immobility, trauma, obesity, family history of genetic thrombophilias, hormonal contraceptives, pregnancy, smoking, varicose veins, certain blood disorders and certain inflammatory diseases.
• Pulmonary embolism: sudden obstruction of a pulmonary artery or one of its branches by a blood clot, generally originating from a deep vein in the lower limbs (phlebitis).
7/ Vascular pathologies :
• Angina/myocardial infarction: partial obstruction (angina = angina pectoris), or total obstruction (myocardial infarction) of one or more coronary arteries by atherosclerotic plaques, most often.
• Vascular aneurysm (/dilation): abnormal enlargement of a vessel. Causes: hypertension, genetic diseases