What are the cardiovascular diseases and necessary medical examinations

Disorders of the blood vessels or heart affect the outcome of the cardiovascular system. Patients with heart disease or cardiovascular complications may have one or more of the following conditions [1].

1. Endocarditis (inflammation of the endocardium caused by infection, which is the inner surface of the human heart)

2. Rheumatic heart disease (indicated by permanent damage to heart valves in patients [less than 25 years of age] with rheumatic fever)

3. Abnormalities in the conduction system (referred to as arrhythmias)

4. Aortic atherosclerosis (or the buildup of plaque or fat inside the aorta)

5. Peripheral artery disease (blockage of the blood vessels between the legs and the heart)

6. Cerebrovascular disease (a disorder of the blood supply within the brain)

7. Coronary artery/heart disease (decrease in myocardial perfusion and increase in oxygen/demand for blood supply to the myocardium)

Accurate and timely evaluation of cardiology is the need of the hour

Humanity's increasing reliance on artificial intelligence and changing lifestyles continue to raise the risk of cardiovascular disease on a global scale [2]. The ratio of deaths from cardiovascular complications in the United States is 1:4, which indicates that out of every four deaths, one is due to cardiovascular disease [3]. Lack of physical activity, increased dependence on fast food, and high spending on digital platforms are among the main causes of heart disease in the current era [4]. Therefore, awareness of cardiovascular disease and timely investigation are absolutely essential to reduce the significant loss of quality-adjusted life years in affected patients. In addition,

Electrocardiogram (ECG)

An electrocardiogram (ECG) tracks the functions of the human heart by recording noticeable changes in its electrical potential [5]; Recordings are tracked through the surface of the body. Dutch physician William Einthoven invented this technique in 1902 [5]. Appropriate interpretation of ECG results is key to minimizing treatment delays and misdiagnosis. Patients with one or more of the following signs/symptoms require an ECG-based evaluation of their heart function.

• seizures.
• fainting.
• pain in chest.
• difficulty breathing.
• cyanosis
• Dizziness.
• palpitation.
• Hypertension.
• Reduction of Blood pressure.
• arrhythmia.
• Bradycardia.
• shock.
• hum.
• Hypothermia.

In addition, an ECG-based cardiac function analysis is recommended to improve the medical decision-making process in the following cases [6].

1. Adverse events arising from treatment.

2. Rhythm disorders.

3. Electrolyte imbalance, electrolyte imbalance.

4. Congenital heart disease.

5. Cardiopulmonary resuscitation.

6. Sharp heart.

7. Metabolic disorders.

8. Rheumatic heart disease.

The 12-lead ECG uses electrodes (sensors), alcohol rub/gauze, tape roll, scissors, blades, skin adhesives, ECG paper, and an ECG or cardiac monitor [7]. Includes 10 wires attached to 6 pre-made wires (V1-V6) and 6 terminals (aVF, aVR, aVL, III, II, and I) [8]. Possible risks and complications include trials of treatment due to misinterpretation and allergic reactions or irritation from the electrodes [5].

Cardiac stress imaging

Cardiac stress imaging is a technique for determining the ability of the human heart to withstand stress. It is a potential method for evaluating exercise capacity, myocardial viability, valvular function, and coronary perfusion. This technique stresses the patient either through exercise or by injecting a therapeutic agent. Imaging methods include positron emission tomography (PET) or single photon emission computed tomography (SPECT). Imaging techniques are preferred over stress testing during exercise assessment of ischemia. Stress testing is recommended for patients with one or more of the following conditions [9].

1. Patients with myocardial infarction >4 days

2. Asymptomatic patients with a definitive diagnosis of unstable angina.

3. Patients with a change in clinical status and a known history of coronary artery disease.

4. Patients at risk of developing coronary artery disease based on symptoms, age, or sex.

5. Patients with ST depression less than 1 mm at rest or right bundle branch block.

6. Patients with arrhythmias.

7. Exercise-induced.

8. Patients with a history of revascularization.

Stress echocardiography identifies cardiovascular complications with an accuracy of 83% and a sensitivity of 88% [10]. The main advantages of this diagnostic technology are provided below [11].

1. Evaluation of pulmonary pressure, diastolic 

function and the condition of the heart valves 2. Evaluation of the lethargic / stupor of the heart muscle.

3. Cost-effectiveness.

4. Avoid exposure to radiation.

Disadvantages of stress echocardiography include its time-sensitive approach, dependence on the interpreter, high risk of biased results in patients with obesity, chronic obstructive pulmonary disease, conduction abnormalities, arrhythmias, and excessive tachycardia [9, 12].

1. Patients with glaucoma and obstructive hypertrophic cardiomyopathy.
2. Patients with unstable (persistent) angina and associated symptoms.
3. Patients with hemodynamic instability and arrhythmias.
4. Patients with severe aortic stenosis.
5. Patients with acute decompensated heart failure.
6. Patients with aortic dissection, pericarditis, endocarditis, or myocardial infarction. (The evaluation period is less than two days).

Coronary tomography angiography (CCTA)

Coronary tomography of the coronary artery (CCTA) is the most preferred technique for detecting coronary artery lesions or more than 50% coronary artery stenosis with a negative predictive value of 99%, specificity of 95%, and sensitivity of 90% [13]. Coronary artery calcium score with uncontrast CCTA determines the risk of coronary artery disease in patients with chest pain. The procedure is contraindicated in patients with renal impairment, acute myocardial infarction, decompensated heart failure, hemodynamic instability, non-adherence to imaging guidelines, and contrast-induced anaphylaxis. The potential advantages of CCTA are listed below [13].

1. Possibility to visualize coronary anatomy, including the structure of the arterial lumen.

2. The ability to predict myocardial ischemia by evaluating severe obstruction/stenosis.

3. Evaluation of coronary artery disease.

4. Predicting acute coronary syndrome.

5. Fibroblast tracking.

6. High diagnostic accuracy and cost-effective.

Possible complications of CCTA include contrast-related allergy and anaphylactic reaction, which is managed with diphenhydramine/standard oral steroids [14].

Make medical decisions

Cardiologists should thoroughly investigate patients' clinical presentation and use appropriate diagnostic methods to improve medical decision-making. In addition, consideration of patient characteristics, including age, gender, location, and treatment history is necessary for risk classification. Finally, correct interpretation of results is critical to improving treatment outcomes and reducing preventable complications.

Note: A comprehensive description of ECG, cardiac stress imaging, and CCTA techniques is beyond the scope of this article.