Little Dictionary of Cardiology

Abdominal Obesity
The most recent scientific knowledge points to the special attention to abdominal obesity. This is due to the accumulation of fat around and within the abdominal viscera, such as the liver. Now this intra-abdominal fat consists of fat cells, adipocytes that are true endocrine organs, because they produce toxic substances for our heart, arteries and pancreas. In addition to stimulating the development of cardiovascular risk factors such as high blood pressure, low-density high-density cholesterol (the good fraction of cholesterol), elevated triglycerides, and the tendency to develop diabetes, these toxins have a direct pro-atrogenic effect on the arterial wall. Incidentally this set of risk factors is known by the name of metabolic syndrome. The measurement of abdominal perimeter is a simple and fast method to diagnose the presence of excess intra-abdominal fat, since the two correlate closely with each other. The presence of an abdominal perimeter, greater than 102 cm in men and 88 cm in women, measured slightly above the navel, is the most important element to make the diagnosis of metabolic syndrome. The individuals thus identified are at high risk of cardiovascular events, so they require an intervention to reduce this risk, which involves first of all the adoption of a healthy diet and regular physical activity.

Arrhythmias
Any disturbance of the rhythm of the heart. They can be slow (bradyarrhythmias) or fast (tachyarrhythmias); may be sporadic or maintained; vary in severity symptoms from the common and usually harmless extra-systoles (premature heartbeat) to the usually fatal ventricular fibrillation.

Arterial hypertension
Arterial hypertension is the most important Public Health problem in Portugal, being responsible for a high number of cardiovascular complications. The blood pressure values of each individual are determined by the pressure at which the blood circulates in the body’s arteries, as a result of the pumping action that the heart makes the pulse. Thus, each time the heart contracts (systole), blood is expelled through the aortic artery. The maximum pressure reached during the blood expulsion is called systolic pressure (maximum pressure). Then, the pressure inside the arteries will descend, as the heart relaxes. The lowest pressure reached is called the diastolic pressure (minimum pressure). Each individual’s blood pressure or blood pressure varies from moment to moment in response to different activities and emotions. It is important to know that in some individuals the blood pressure rises, in the act of the measurement, only by the presence of the doctor (alarm reaction), being then called “white coat hypertension”. For this reason, it is sometimes difficult for the doctor to decide, in a single visit, whether a particular individual is hypertensive. However, blood pressure tends to drop to the individual’s usual values as he gets used to measurement maneuvers and to the doctor, on successive visits. It is therefore necessary, above all, with only slightly elevated blood pressure levels, for the patient to be observed in several visits, for a few months, before the diagnosis of hypertension and its therapy can be safely established. During this waiting period, when, incidentally, if medication should not be administered, the individual suspected of hypertension should start a program of non-pharmacological measures.

An individual is considered to be hypertensive when their blood pressure is repeatedly greater than or equal to 140mmHg for systolic and /or 90mmHg for diastolic. However, for certain patients, such as diabetic or kidney patients or those with cardiovascular disease, it is recommended that they should have values below 130 / 80mmHg. There is no clearly defined definition for blood pressure values in children. However, it is generally considered that tension values above 110/70 mmHg should be considered suspect before 10 years of age. With age, blood pressure tends to rise. However, high blood pressure in the elderly should not be considered normal.

Atherosclerosis
Atherosclerosis is a disease in which the arteries become narrowed due to cholesterol deposits, commonly called atherosclerosis plaques, in the interior of the arterial wall. These cholesterol deposits cause an inflammatory phenomenon that causes the arteries to harden, with increased fibrous tissue and calcification of the affected walls. As the plaque grows, it narrows the lumen of the artery, thereby reducing the influx of blood and oxygen to the affected organ, which can be the brain, heart, kidney, limbs, etc. If the artery is completely blocked, without blood passage, a myocardial infarction or stroke may occur, for example. The exact cause of atherosclerosis is not fully known; however it is known that certain factors, therefore called risk factors, are the basis for the development of atherosclerosis. High blood pressure, high cholesterol, smoking, diabetes, obesity, lack of physical activity and a diet too rich in saturated fat from red meat, fatty dairy products and fastfood, as well as heredity are known factors of atherosclerosis. Fortunately, the control of risk factors through a healthy lifestyle, as well as the use of medication, when indicated by the doctor, are effective in preventing and controlling atherosclerosis and its complications.

Body Mass Index (BMI)
Relationship between body weight is the square of height (BMI= weight (Kg) / height2 (m)). This very easy-to-assess parameter is a good indirect indicator of body fat. It is considered normal between 18.5 and 25.

Breakfast
Breakfast is the first meal of the day and as such should be made as close as possible to waking up. It should be balanced, with foods from the various groups in order to meet the nutritional needs that occur with long night fasting. Several studies have shown that there is a higher prevalence of overweight and obesity in individuals who do not usually eat breakfast.

Cardiac rheumatism
Heart disorder that arises as a consequence of infection by a bacterium (a strain of streptococcus) usually at the level of the oropharynx (tonsillitis). This infection, if left untreated, can progress to rheumatic fever, which among other organs can reach the heart acutely or chronically, many years after the initial infection. The more widespread use of antibiotics has made the appearance of new cases of this disease very rare.

Cardiology
It is the medical specialty that deals with the diagnosis and treatment of diseases related to the heart and circulatory system.

Cardiovascular risk factors
The same as a risk factor, when the disease or cause of death associated with it is one of the diseases of the circulatory system.

Cholesterol
Cholesterol is an essential fat existing in our body, which has two origins: one part produced by the body itself, in particular the liver, and another part obtained through food, in particular by the intake of animal products such as meat, eggs, and dairy products.

If the cholesterol is in excess, it is deposited in the arterial walls, constituting plaques that reduce the caliber of the vessels, hindering the influx of blood to the organs and tissues of the body When oxygenated blood does not reach enough to the heart muscle can occur a pain in the chest – the so-called angina. If coronary artery obstruction is complete, a myocardial infarction can be triggered. European scientific societies recommend, as normal values a cholesterol below 190 mg/dl when it comes to the general population, In the case of patients with coronary pathology, or other atherosclerotic disease (stroke, peripheral vascular disease, etc.), diabetes or renal failure cholesterol values below 175 mg/dl are recommended. For LDL cholesterol, the recommended values are respectively below 115 mg/dl for the general population and 100 mg/dl for high-risk patients. For HDL, levels below 40 mg/dl and triglycerides greater than 150 mg/dl confer increased cardiovascular risk. On the other hand, the higher hdl, the lower the risk of cardiovascular disease.

Diabetes
Diabetes is a disease in which the body does not produce, or does not properly use insulin. Insulin is a hormone produced by the pancreas that sends glucose (blood sugar) into cells, where it is converted into energy. If glucose does not enter the cells, it accumulates in excess in the blood, giving rise to the symptoms of diabetes. Although people with diabetes may have no symptoms, these when they exist are: increased thirst, increased diuresis, and appetite, fatigue, blurred vision, frequent infections, erectile dysfunction, etc. The diagnosis of diabetes is established based on: fasting glycemia – greater than 126 mg/dl on at least two occasions. When blood glucose is between 100 and 125 mg/dl indicates prediabetes. In the glucose overload test, the sugar level is measured fasting and 2 hours after the patient ingests a drink with 50 mg of sugar. If the blood glucose value is greater than 200 mg/dl, you confirm the diagnosis of diabetes.

There are two main types of diabetes: type 1 diabetes in which the pancreas stops producing insulin. It is estimated that 5-10% of diabetics have this type of diabetes, which usually appears in young people and requires insulin therapy In type 2 diabetes the pancreas secretes insulin, but the body is not able to use it. It is insulin resistance, which the body tries to overcome by synthesizing more and more insulin until the pancreas runs out, at which point diabetes begins. About 90% of diabetes cases are type 2. It usually arises from the age of 45 and is often associated with obesity. These patients have a very increased cardiovascular risk which accounts for more than two-thirds of deaths, usually from myocardial infarction, strokes and heart failure. Type 2 diabetes is usually controlled with diet, exercise and oral medications. Only in very advanced cases it is necessary to resort to insulin. A tensional glycemic control of cholesterol, non-smoking and a healthy lifestyle avoid the complications of diabetes.

Electrocardiogram
Graphic record of the electrical activity of the heart, collected on the surface of the body through 10 electrodes, also commonly referred to as E.C.G.. Rapid and painless examination, being one of the oldest used by modern cardiology, still maintains a great value for the diagnosis of arrhythmias and acute cardiac situations. Provides less specific information regarding chronic changes in cavities and cardiac contractility.

Exercise
Type of physical activity in which the movement is repetitive, properly structured and planned, with the aim of improving or maintaining the physical condition.

Fats
Fats also known as lipids are a class of nutrients. Fats are produced by both vegetables and animals and are a group of compounds, insoluble in water but generally soluble in organic solvents.

Chemically, fats result from the union of three fatty acids to a glycerol molecule, forming a triester. They may be called triglycerides, or more correctly triacylglycerols. They have a molecular structure made up of several carbon chains, linked together and that can have different lengths. Fats can be differentiated into saturated, mono- or polyunsaturated, depending on their chemical structure. Fats can be solid or liquid at room temperature, depending on their structure and composition.

Healthy Living
Life full of habits, behaviors and attitudes that reduce the probability of occurrence of an objective or subjective deviation from the physical and mental well-being of the individual, as a social “animal”, in its interaction with others.

Healthy Eating
Food that enables human beings to live a long and healthy life. It should be balanced in terms of nutrients, varied, with a caloric content according to energy expenditures, pleasant to the palate, satiating and free of harmful or toxic products. There are many dietary patterns in the world that can meet these requirements. The Mediterranean food pattern, described about 50 years ago by Keysfrom studies in European countries of the Mediterranean basin is one of the most recognized and investigated. In Portugal the new Food Wheel seeks, in a simple way, to recommend to the general population a healthy eating pattern.

Heart
Muscle consisting of 4 cavities (two auricles and two ventricles) located in the rib cage, behind the sternum and slightly left-facing and whose function is to boost and thus distribute, to all parts of the body, the blood that has been oxygenated in the lungs, and take it back to the lungs to be oxygenated again.

Heart Block
The heart has a rapid system for conducting electrical stimuli through its structures in order to ensure an adequate rhythm, synchronization and sequence in the contractility of the auricles and ventricles. A partial or total interruption at some point in this system constitutes a blockage, which can be detected by electrocardiogram.

Heart Failure
Heart failure is a common disease that usually develops slowly ‘ as the heart muscle loses strength to maintain a normal flow of blood through the body. Heart failure develops after an acute or continued aggression to the heart, as is the case after a myocardial infarction, years of arterial hypertension, diabetes or the defect of a heart valve. Symptoms of heart failure are: shortness of breath, which can arise for light activities, difficulty breathing in the lying position, edemas of the legs and ankles, due to fluid retention, fatigue and lack of strength, etc. Many patients with heart failure are unaware that they are sick and misattribute their symptoms to age. Others abandon some activities to avoid symptoms. Patients with heart failure should restrict salt intake, weigh themselves daily, and do the physical activity recommended by the doctor. It is important that the diagnosis is made as soon as possible, especially since the treatment will improve symptoms, reduce complications and hospitalizations and increase life expectancy.

Morbidity
Any objective or subjective deviation from the physical, mental or social well-being of an individual.

Mono and polyunsaturated fatty acids
Monounsaturated fatty acids have a double bond in one of the molecules. It is a more characteristic fat of plant foods such as olive oil, peanuts and some types of nuts. Helps reduce “bad” cholesterol (LDL) without reducing HDL-Cholesterol levels. Polyunsaturated fatty acids have several double bonds between the molecules in the chain. They are characteristic of seeds and vegetables such as sunflower, corn, soybean and also fish fat.

Polyunsaturated fat increases HDL or “good cholesterol” levels and lowers LDL levels or “bad cholesterol”” Unsaturated fats are healthier than saturated ones but like any fat should not be consumed in excess.

Myocardial infarction
The heart muscle (myocardium), like any other muscle, needs to be irrigated to receive the oxygen that allows it to work. When you don’t have enough oxygen, your heart muscle starts to suffer. Blood is supplied to the myocardium by the coronary arteries. When cholesterol is in excess, it is deposited in the arterial walls, constituting plaques that reduce the caliber of the vessels, hindering the flow of blood to the organs and tissues of the body. When oxygenated blood does not reach enough to the heart muscle can occur a chest pain – the so-called angina. If coronary artery obstruction is complete, a myocardial infarction may be triggered, with death of part of the myocardium. Risk factors for coronary heart disease are high cholesterol, high blood pressure, smoking, diabetes, physical inactivity and heredity. The classic symptoms of a heart attack are chest pain accompanied by shortness of breath, abundant sweating and nausea. Chest pain is described as tightness, weight or even pain. Unfortunately, many people do not have these classic symptoms and may feel only indigestion, pain in the lower jaw, pain in the shoulder or left upper limb, shortness of breath, nausea and vomiting. Sometimes the symptoms are minimal and patients do not realise that they are suffering a heart attack. This often occurs in women, the elderly and diabetics. Sometimes the only symptom is extreme weakness or great fatigue. Chest pain is almost always an emergency so, in case of suspicion, medical emergency should be immediately triggered. A lot of people die because they don’t seek the urgency of the hospital. It is preferable to go to the hospital for suspected myocardial infarction and come to the conclusion that everything was fine, than to die at home for lack of medical assistance.

Nutrition
Nutrition is a biological process in which living beings, from food, assimilate their nutrients to perform vital functions to the body. Human nutrition is the science that studies the relationship between food intake and disease.

Obesity
Chronic disease defined as a Body Mass Index equal to or greater than 30. It is associated with numerous complications such as cardiovascular diseases, diabetes, sleep apnea syndrome, osteoarthrosis, gout, neoplasms, infertility, psychological and socio-professional problems, decreased quality of life and premature mortality. The prevalence of overweight or pre-obesity (BMI 25-29.9) and obesity have been increasing worryingly in all age groups, from children to old age. The main causes are sedentary lifestyle and inadequate nutrition linked to the lifestyle of modern societies.

Physical Activity
It is all the body movement produced by skeletal musculature and that results an energetic expenditure above the resting level. It’s one of the first things a child wants to do and one of the last things everyone wants to stop doing.

Primary prevention
Set of measures and actions aimed at preventing the early onset of disease or undesirable health conditions.

Risk factors
Set of environmental or behavioral agents that are associated with an increased likelihood of suffering an illness or a cause of death.

Salt
Generic term of a chemical substance, (sodium chloride) which, in addition to the many uses in the industry, is used in the manufacture of food to enhance their taste and to preserve them.

Saturated fatty acids
Saturated fatty acids have simple bonds between carbon molecules. It is the fat of animal origin and is usually in the solid state. These fatty acids are related to the higher production of LDL cholesterol, contributing to the formation of atheroma plaques, increasing the risk of cardiovascular diseases.

Screening
Use of tests, tests or other measures that are practical and quick in their application and that allow the identification of those who are likely to have an increased likelihood of suffering or having a disease which, by their characteristics is not yet evident, is identified. A screening test or test is not a diagnostic test.

Secondary prevention
A set of measures and actions that, in view of the recognition of an undesirable disease or health condition, aim to intervene as early as possible so that the objective or subjective deviation from the physical, mental or social well-being of the individual is minimized.

Sedentary lifestyle
Lifestyle with reduced physical activity. It is associated with a higher risk of various diseases, including cardiovascular and metabolic diseases. To avoid this risk factor, a minimum of 30 minutes of physical activity (such as walking) is recommended for 5 or more days a week.

Tertiary prevention
Set of measures and actions that seek to restore and rehabilitate the individual contrary to the natural evolution of the disease.

Thrombosis
Formation of a thrombus or clot is a response of the hematological system to a slowing of blood velocity, to the presence of foreign materials to the body or to an injury of the vascular wall. Platelets and numerous clotting factors are required for the formation of thrombi present in the blood. Thrombus formation is an important response in trauma situations (to stop bleeding, for example). However, they can cause damage if they form inside the arteries (reacting to atherosclerosis plaques), or inside the veins or varicose veins, obstructing the passage of blood. There are still situations in which they can form within the heart; when an already formed thrombus is released, it can be transported by blood into the pulmonary, cerebral or other distant territories, constituting what is called an embolism.

Source:

Portuguese Foundation of Cardiology, 2014