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The order of the cardiovascular diseases: Pathogenetic cascade and clinical implicationsCardiovascular disease (CVD) is the leading cause of death and include a variety of symptoms, which occur at different levels of the cardiovascular system. An analysis of their typical order allows for a better understanding of the pathogenetic mechanisms and to optimize the prevention and therapy.1. Predisposing factors and early damageThe development of CVD often begins with predisposing risk factors, including:Hypertension;Dyslipidemia;Diabetes mellitus type 2;Overweight/Obesity;Tobacco consumption;lack of physical activity.These factors lead to endothelial dysfunction, the first step in the cascade. The endothelium, the inner layer of the blood vessels, it loses its ability to provide adequate vasodilation and shows an increased tendency to Inflammation.2. Atherosclerosis as a Central processThen, atherosclerosis develops: lipids (especially LDL cholesterol) deposits in the vascular wall, which triggers a chronic inflammatory response. Macrophages phagocytize the oxidized lipids to form foam cells, which Atheromas develop. These Plaques narrow the vessel lumen and reduce the flow of blood.3. Clinical manifestations according to the affected vesselsDepending on the localization of atherosclerosis different disease pictures:Coronary heart disease (CHD): narrowing of the coronary arteries leads to Angina pectoris, acute thrombus formation to myocardial infarction.Cerebro-vascular disease, atherosclerosis of the cerebral arteries is seizures cause of transient ischemic attacks (TIA) or stroke (apoplekti cher hit).Peripheral arterial occlusive disease (paod): restriction of the blood flow in the extremities leads to pain when walking (intermittent Klaudikation) and Gewebsschäden in the advanced stage.4. Heart failure as a result ofMyocardial infarction and chronic conditions (e.g. hypertension) cause damage to the heart muscle. As a result, the heart loses its pumping function, which leads to heart failure. This is manifested by symptoms such as dyspnea, Edema and Fatigabilität.5. Arrhythmias and other complicationsStructural changes of the heart (e.g., scar tissue after infarction) promote electrical dysfunctions. So arrhythmias, including atrial fibrillation is a risk factor for stroke caused.6. Cycle progressionThe sequence is not strictly linear: heart failure can worsen hypertension, arrhythmias increase the thromboembolic risk. These interactions often lead to a self-reinforcing cycle of complications.SummaryThe typical sequence of CVD can be roughly divided as follows:Risk factors → endoteliale dysfunction → atherosclerosis → regional Ischemia (coronary artery disease, stroke, peripheral arterial disease) → organ damage (heart failure) → secondary complications (arrhythmias, thromboembolism).Early Intervention in this cascade, for example by lowering the blood pressure, lipid-lowering drugs and lifestyle changes can slow the Progression of cardiovascular diseases significantly and the quality of life and expectation of the patient significantly improve.
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