Practical insights into pathophysiology of heart disease
Practical Insights into Pathophysiology of Heart Disease
- Introduction
- What is the Pathophysiology of Rheumatic Heart Disease?
- What is the Pathophysiology of Ischemic Heart Disease?
- How does Heart Disease Intermittent Fasting Help?
- What is Atherosclerosis Heart Disease and How can it be Prevented?
- Which Body System is Directly Affected When a Person has Heart Disease?
Introduction
Most of us are aware of commonly known heart conditions and the outcomes. However, despite this knowledge, fatalities and adverse events from poor heart health continue to rise. This is because of a lack of awareness of how the disease develops and the risk factors. Here is a look at the pathophysiology of heart disease to help you take the right measures for prevention and reducing risk.
What is the Pathophysiology of Rheumatic Heart Disease?
This involves a complex sequence of actions following strep throat infection or scarlet fever. Let’s look at the pathophysiology of heart disease specifically rheumatic heart disease in detail:
- Initial infection
RHD typically begins with an infection of the throat from Group A Streptococcus bacteria. This infection causes rheumatic fever, that affects various organs such as the heart, joints, skin, and brain.
- Immune response
Following this, the body’s immune system produces antibodies to fight the infection. But, as a result of what is known as molecular mimicry, these antibodies end up attacking the body’s own tissues. For instance, some of the tissues in the heart have protein that is similar to those in the bacteria, and therefore the heart valves are affected.
One of the outcomes of this autoimmune response is inflammation in the heart, especially in the endocardium, myocardium, and pericardium.
- Rheumatic fever
The next phase is the acute phase, where the inflammation affects the heart tissue, causing rheumatic carditis. The heart valves, especially the mitral valve and aortic valve, end up inflamed, thickened, with scarring. This affects the functioning of the valves, restricting blood flow, causing blood to flow backward etc.
- Fibrosis
Gradually, as a result of repeated episodes of inflammation the heart valves suffer damage, causing thickening and stiffening, known as fibrosis. This severely affects the functioning of the heart.
- Heart failure
With extensive damage, the burden on the heart to pump blood increases. This extra workload causes heart enlargement, weakens the heart muscle, and results in heart failure.
What is the Pathophysiology of Ischemic Heart Disease?
Also known as coronary artery disease, this is mainly due to reduced flow of blood to the heart muscle. This is the result of narrowing or blockage of the coronary arteries, resulting in poor oxygen supply to the heart. Here is a step by step break down of the pathophysiology of heart disease specifically ischemic heart disease.
- Atherosclerosis
This is regarded as the most common cause, beginning with accumulation of low-density lipoprotein cholesterol and other substances. This accumulation is on the inner walls of the coronary arteries, resulting in the formation of plaque. Risk factors that cause damage to the inner lining of the artery include LDL cholesterol, blood pressure, smoking, diabetes and chronic inflammation.
- Endothelial dysfunction
The role of the endothelium is to help arteries relax and control blood flow. As a result of atherosclerosis, this function is affected and the arteries do not relax as required. This impacts flow of blood to the heart.
- Oxygen supply
With narrowing coronary arteries, the heart muscle does not receive adequate oxygen-rich blood. This makes the heart muscle to become ischemic, causing chest pain.
- Thrombosis
There is a possibility of the plaque in the coronary artery rupturing, and the body’s system attempts to repair this by forming a blood clot. This blood clot blocks or obstructs the artery, causing chest pain, and possible heart attack. The latter occurs when there is complete blockage of the coronary artery cutting off blood flow.
- Myocardial Ischemia
Myocardial ischemia is due to reduced blood supply that weakens the heart muscle. When the flow of blood is restored either through medications or other actions, the heart muscle recovers. When the blockage lasts for a long period, myocardial infarction or heart attack occurs, wherein cells in one part of the heart muscle die.
How does Heart Disease Intermittent Fasting Help?
With the important information about pathophysiology of heart disease covered, let us look at the impact of intermittent fasting on heart health. This is being studied for possible effect in reducing the risk of heart disease. The approach involves phases or periods of eating alternating with periods of fasting. This includes approaches like the 16:8 method or the alternate day fasting method. Let us look at how it may work in improving heart health.
- Lipid levels
This method of fasting may help lower LDL and triglycerides, that cause development of atherosclerosis. By reducing these levels, the narrowing of arteries which is the main cause of ischemic heart disease can be prevented.
- Insulin resistance
Type 2 diabetes is closely related to heart disease and one of the causes of diabetes is insulin resistance. Intermittent fasting helps improve insulin sensitivity, permitting the body’s utilization of glucose, reducing the risk of diabetes. This, in turn, brings down the risk of cardiovascular health issues.
- Weight management
Obesity is a significant risk factor for heart disease and intermittent fasting helps reduce calorie intake, bringing about weight management. This also helps reduce the strain on the heart, bring down blood pressure levels, and improve cardiovascular health.
- Blood pressure
Hypertension causes damage to the arteries making the heart to work harder, and increasing risk of heart disease. Intermittent fasting can bring down blood pressure levels, reducing the burden on the heart and improving heart health.
Other benefits include reducing chronic inflammation, improving cellular repair, and improving heart rate variability.
What is Atherosclerosis Heart Disease and How can it be Prevented?
As part of understanding the pathophysiology of heart disease, let us look at coronary artery disease. This condition occurs due to narrowing or blockage of the arteries, due to buildup of plaque.
- Plaque – forms due to damage to the inner lining of the arteries, and accumulation of cholesterol and fats.
- Narrowing of arteries – happens over time due to this plaque buildup.
- Flow of blood – is reduced cutting off oxygen-rich blood supply.
- Plaque ruptures – resulting in formation of blood clots, blocking the artery completely.
Which Body System is Directly Affected When a Person has Heart Disease?
As part of understanding the pathophysiology of heart disease here is a look at systems affected by heart disease. The heart is unable to pump blood effectively, and narrowing or blockage of the coronary arteries cause reduced flow of blood to the heart muscle. Hypertension strains the heart and blood vessels, while heart diseases increase the risk of formation of blood clots. Other systems affected include:
- Respiratory system.
- Renal system.
- Endocrine system.
- Nervous system.
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Shetty B s a cardiologist in Chennai, with extensive experience in the field. He completed his MBBS from Madurai Kamaraj University, followed by an MD in General Medicine and a DM in Cardiology from The Tamil Nadu Dr. M.G.R. Medical University (TNMGRMU).