Dr Alnoor Abdulla: Cardiovascular Diseases Overview
cardiovascular-diseasesCardiovascular diseases (CVD) are those that affect the heart (cardiac) and the blood vessels all over the body (vascular) (Fig 1). The primary function of the heart is to continuously circulate the blood all over the body through the vascular system, to deliver oxygen and nutrients to all the organs. It is thus the muscular pump, that beats rhythmically about 50 to a 150 times a minute as needed from the time we are in the womb till the moment we die. Non-stop.

The heart itself continuously needs oxygen and nutrients for this mechanical, energy consuming function. It receives these through the vascular system of the heart, called the coronary arteries, (Fig 2), which run on the surface of the heart, permeating into the muscle to deliver these nutrients.
The rate and rhythm of this cardiac contraction is initiated and governed by the specialized, natural electrical pacemaker of the heart (sino atrial node). The electrical signal travels through the heart to synchronize the rhythmic contraction of the upper (atria) and lower (ventricles) chambers, through specialized fibers –the conduction system (Fig. 3).
In order to allow efficient and unidirectional pumping of the blood, the heart has two separated upper chambers – one (right atrium), which receives, deoxygenated (“used”) blood from the body organs and the other (Left atrium) receives the oxygenated blood from the lungs. The blood then flows into the two separated lower chambers to be then pumped (“used” blood) to the lungs from the Right ventricle and the oxygenated (“clean”) blood out to the body from the Left ventricle. This requires the muscular contraction work of the ventricles and the four valves in the heart, which allow flow in one direction and prevent back flow (no leakage). (Fig 4).

To review an excellent audio-visual animation of the heart function click here

Next blog we will discuss the categories of Cardiovascular diseases so as to understand the common forms and the commonly used terminology.

Dr Alnoor Abdulla: Categories of Cardiovascular Diseases
Having understood the basic structure and function of the heart we can now categorize the CVD into three main groups:

  1. Plumbing problems: These diseases primarily affect the vascular system. This could be the blood vessels of the heart—coronary arteries—which could get thickening, narrowing and obstruction—Atherosclerosis --  “hardening of the arteries” leading to angina (chest pain from the heart due to lack of oxygen) or heart attacks (damage to the heart muscle due to blocked blood supply) or sudden death (unanticipated death in someone thought to be healthy or in stable condition occurring quickly). (Fig 1)

The plumbing problems (atherosclerosis) could involve the arteries to other organs such as the brain leading to Stroke (paralysis or death), (Fig2), dementia, bleeding in or around the brain, etc.

Involvement and obstruction of the arteries in the legs (Fig 3) could lead to Claudication (pain in the leg or hip muscles due to lack of oxygen) or even gangrene and could require amputation.

The whole vascular system could be involved leading to Hypertension (high blood pressure) (Fig 4).

So the vascular disease could be the same in all parts of the body (such as atherosclerosis), but the clinical manifestations in any given patient would depend which organ develops the vascular blockage—coronary artery blockage—heart attack, brain artery blockage—stroke, leg artery blockage—gangrene, etc.

  1. Electrical problems: These diseases affect the specialized natural pacemaker of the heart (SA Node), the electrical junction box in the middle of the heart (AV Node) or the specialized fibers, the conduction system (“electrical wires”). (Fig 5)

This can lead to the heart beating very slow or even stopping from time to time (often the patient passes out transiently) requiring the insertion of an artificial pacemaker to treat the problem and stabilize the patient.(Fig 6)

The opposite could happen as well. There could be episodes of very rapid heart rates or irregular heart rates (“palpitations”) (Fig 7) suddenly making the heart function inefficiently and significantly dropping the blood supply to the heart muscle itself or the brain, leading to angina (chest pain from the heart), lightheadedness, unconsciousness, fatigue, etc. The blood could stagnate in the heart leading to formation of clots, which could then fly out into the circulation and causing blockages in the organs where they land—such as strokes in the brain (Fig 8). This could require treatment with medications (anti arrhythmic agents and / or anti coagulants—blood thinners). Some patients may need specialized artificial pacemakers, cardiac procedures to ablate (“burn out or laser or freeze) the culprit electrical malfunctioning “sparking” or “short circuit” spot in the heart, or may require other specialized cardiac surgery.

  1. Pump problems: These are conditions which lead to heart muscle damage or intrinsic muscular disorders affecting the heart specifically or as part of other systemic, genetic or metabolic diseases in the body. Disorders of the heart valves (narrowing –stenosis or leaking –regurgitation) lead to pump malfunction as well.

All these diverse diseases essentially lead to the heart unable to pump the blood efficiently around the body, there is lack of required nutrient delivery to the body for its energy demands, blood backs up in the heart, lungs, abdomen and extremities. This is “fluid retention” (Edema). This then is the overall condition of “Heart failure”, which can be slowly, chronically, progressive or present acutely initially or during exacerbations of chronic heart failure. This leads to considerable disability, repeat hospitalizations and death.

There is often overlap in these three areas of malfunction, one leading to the other or one aggravating the other, although the primary initiating disorder is usually in one of these three categories.

So being a cardiologist, is all about knowing the Plumbing, Electrical and the Pump malfunctions of the Heart and how to treat them.

Famed cardiologist Dr. Alnoor Abdulla forced to retire due critical illness
Dr Alnoor Abdulla upon gradiationDr. Alnoor Abdulla is glad to be alive. A 30 year veteran of the world of cardiology, he knows first-hand that most people diagnosed with the severity of cardiac disease that he has would not have lived to talk about it.

A strong family history of cardiac disease and high cholesterol, an intensive workload, and years of stress and long work hours all caught up with Dr. Abdulla when, ironically, the cardiologist himself fell victim to severe coronary artery disease.

In 2005 he was diagnosed with blockages in all three of his main coronary arteries and needed an extensive balloon angioplasty and insertion of several drug-coated stents. But the disease was aggressive and progressed. He endured multiple medications, 10 angiography /angioplasty procedures and insertion of a total of 8 drug coated stents over the next six years.

Things got worse in the spring of 2012, and Dr. A’s condition took a very severe down turn. He had urgent major coronary bypass surgery at St. Paul’s Hospital, where the surgeon had to perform five bypasses. There were complications and his post-op course was very difficult. After a slow, gradual recovery another setback hit four months later: the return of angina and new blockages in three of his bypasses and one of his own arteries.

All of this illness took a great toll, both personally and professionally. Dr. Abdulla started slowly cutting back on his workload when his health problems began to get serious. By 2008, he had reduced his clinical work to out-patient office, consultative private practice.

But after the critical major cardiac surgery in the spring of 2012, it was clear that things needed to change. His doctor and family strongly urged him to consider retirement from clinical practice. Alnoor notes that “after last-ditch quintuple bypass surgery and a very stormy post op course, my doctors, family and friends all urged me to finally close the practice and get rid of that stress.”

So he slowly tied up his case-load, took care of his patients’ needs, and set them up with other cardiologists. He shut the doors to his practice in the summer of 2012. It was a difficult time, but his health had to take priority.

Today Dr. Abdulla continues his struggle with cardiac issues. He’s closely followed by several specialists, is on a strict diet, a regular Health Heart cardiac rehabilitation program, and is on multiple medications. His prognosis remains uncertain.

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