cardiovascular disease
Heart diseases generally describe malfunction of heart or blood vessels in the body. There are various types of diseases which are hidden under the term of heart disease, connected into several groups or categories:
Coronary artery diseases
Coronary arteries are the vessels that deliver oxygen-rich blood to the myocardium (heart muscle). These vessels are commonly affected by atherosclerosis – a state when the artery walls thicken due to the accumulation of the plaque – degenerative material mostly consisting of macrophage cells (type of white blood cells) or debris, containing lipids, calcium and a variable amount of fibrous connective tissue. The thicken walls block the blood stream into the heart and part of the heart muscle suffers from lack of blood supply. Coronary artery disease includes stable or unstable angina, myocardial infarction (generally know as heart attack) or sudden cardiac death.
Valvular heart disease
This category of disease involves any problem of one or more of the valves of the heart (they are four valves in total). These conditions occur mainly as a consequence of aging but they are also results of inborn abnormalities or of physiologic processes such as rheumatic heart disease (inflammatory heart disease which occurs several weeks after streptococcal throat infection) or pregnancy.
Cardiomyopathy
This group of diseases mostly affects the heart muscle. These diseases cause shortening of the breath, fatigue, swelling of the legs, irregular heart beat and fainting. The risk of sudden cardiac death is increased at the diagnoses of cardiomyopathy.
Other diseases
Except the above mentioned groups of diagnoses connected to heart problems, there are more problem and diseases which can occur as the heart is very complex organ. Cardiac arrhythmia is condition at which the heartbeat is irregular. Hypertensive heart diseases are numerous complications which affect the blood stream and thus the vessels and the heart by high blood pressure. It is the main risk causing the stroke (poor blood flow to the brain results in cell death) . Aortic aneurysm is extreme enlargement of the aorta which causes the weakness in the aortic wall and increases the risk of rupture.
Many studies have already proven the connection between heart disease and infertility issues both in men and women. Studies show that infertility may be the sign for health issues later in life. Generally, both men and women with infertility have an increased risk for developing chronic conditions such as heart diseases or also diabetes in future life. However, it is quite unclear if the heart disease or diabetes causes the infertility, or vice versa. Otherwise, healthy people don’t realize the risk or signs of heart disease until they visit the specialist to discuss infertility issues. Thorough control, hormone evaluation, sperm condition and blood tests may provide not just the information about reproductive issues but also about the current general health of the man and woman in the couple and potential future health issues.
Associated diseases
Complications
Risk factors
Male fertility
Several studies have proven the connection between overall health and sperm parameters and condition. There have been proven that half of the men at the age of 38 have abnormal sperm. Besides, they also found that heart, vascular and blood pressure troubles may play a role as the causes of infertility.
Furthermore, men with infertility issues have higher rates of obesity and smoking, alcohol and drug abuse, depression and hypertension – all the risk factors also for the heart diseases.
Another possibility of heart disease and infertility connection is related to low levels of testosterone in men as the hypogonadism (diminished functional activity of thestes which result in low levels of testosterone) is one of the risk factors for cardiovascular disease.
Female fertility
Polycystic ovary syndrome (PCOS) is one of the major conditions which affects the fertility in women and also is the risk factor for heart diseases. PCOS is endocrine disorder causing hormone imbalance and thus affects menstruation and ovulation. It causes irregular menstruation, inability to get pregnant (as the result of irregular periods and not ovulating – the egg is not released from the ovaries and can’t be fertilized by a sperm cell), hair loss, acne, depression, obesity and insulin issues. if it is not treated properly, it may have long-term consequences, including increased risk for heart disease due to higher levels of insulin, triglycerides and cholesterol, raised blood pressure which all increases the risk of artherosclerosis and thus the heart attack or stroke.
Another risk factor for heart disease for females is fertility therapy itself. Fertility therapy is given to stimulate the ovaries and regulate and induce ovulation. It is mostly based on gonadotropin therapy and the treatment is often used in preparation for IVF and other assisted reproductive technologies.
It has been shown that women who did not become pregnant after undergoing fertility therapy are at greater risk for heart failures and strokes. Long-term impact on heart health is increased and failure of fertility therapy may be an early indicator of future heart disease risk.
The best prevention is in keeping the healthy lifestyle, reducing alcohol consumption, drug abuse and avoiding the smoking. If there are some hormonal imbalance issues, the preventive or checking controls are also beneficial to keep the hormonal imbalance limited and thus to prevent further heart disease besides elimination other symptoms.
Depending on the type of heart disease, the symptoms may vary. At chronicle problems, arrhythmia, swelling of the legs, faint, fatigues, breathlessness are common symptoms. At acute problems such as heart attack or stroke, the faint, chest pain or the feeling of the heartburn occurs.
Lifestyle changes are the first option of self-therapy how to treat heart problems. Eating low-fat and low-sodium diet, avoiding smoking and limiting alcohol intake are the first good approaches in lifestyle changes. Also, getting and physical exercise almost every day is recommended. Reducing stress, for example through relaxation or meditation, and practicing the techniques to manage the stress are also beneficial.
Controlling the blood cholesterol, blood pressure and sugar levels may help to show the severity of the problem or the improvements when changing the lifestyle or also during pharmacotherapy treatment.
There exist a lot of methods to treat acute or chronic problems of heart and arteries supplying the heart with blood. Each of the problems categories and each heart problem may need different treatment. Both pharmacotherapy and surgical therapy are used to treat acute or chronical issues.
Pharmacotherapy
Cardiovascular diseases medication
Most people with high blood pressure require blood pressure medication. It reduces the blood pressure and thus reduce the risk of major cardiovascular events.
Statins (HMG-CoA reductase inhibitors) are a class of lipid-lowering medications. They reduce cardiovascular disease by blocking the pathway for synthesizing cholesterol in the liver adn thus reduicng the accumulation of the plaque in artery. There are numerous statins available: atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. Their combination with other agents is also possible.
Myocardial infarction (heart attack) management
Myocardial infarction requires an immediate attention. Treatment aims to preserve as much heart muscle as possible. Aspirin and nitroglycerin are commonly administered; nitroglycerin is used to improve the blood supply to the heart.
The main treatment involves trombolysis and percutaneous coronary intervention (PCI). PCI is non-surgical procedure to treat narrowing of the coronary arteries of the heart. If PCi cannot be performed within approved time, thrombolysis is used to treat myocardial infarction. Thrombolysis include the agents (stroptokinase or reteplase for example) which activates the enzymes that destroy blood clots.
Surgical therapy
Cardiomyopathic implantations
Treatment of cardiomyopathy may include the lifestyle changes and medication (conservative treatment), However mechanical cardioversion is necessary for more difficult cases. Implanted peacemakers for slowing heart rates, defibrillators to support those with fatal heart rhythms, ventricular assist devices for severe heart failures are used. However, in spite of all these therapies, some patient may later require the heart transplantation.
Nevertheless, even though we can see the connection between heart disease and infertility, it is not known exactly if the primary cause of infertility are the heart diseases or vice versa. As the infertility might be the prediction for increased heart diseases later in the life, solving the problems of heart disease won’t treat the infertility problems, both in men and women. Thus, there is no method of pharmacotherapy or surgical therapy, which can be used to treat infertility problems in connection to heart diseases.
If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilization (IVF). IVF and ART generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
Intracytoplasmic sperm injection (ICSI) is beneficial in the case of male factor infertility where sperm counts are very low or failed fertilization occurred with previous IVF attempt(s). The ICSI procedure involves a single sperm carefully injected into the center of an egg using a microneedle. With ICSI, only one sperm per egg is needed. Without ICSI, you need between 50,000 and 100,000.
Two techniques that enable to some extent the selection of physiologically normal spermatozoa have recently been developed. One of these is termed intracytoplasmic morphology-selected sperm injection (IMSI). Here, spermatozoa are selected for ICSI and analysed digitally prior to the microinjection procedure in order to deselect morphologically abnormal spermatozoa. With this technique, abnormalities not visible in standard ICSI procedures have been observed. IMSI increases the pregnancy rate during ICSI cycles, and some data suggests that the level of pregnancy termination is also decreased. A second technique recently introduced to assisted reproduction is that of sperm selection with hyaluronic acid (HA), e.g. PICSI (Preselected ICSI). In this technique, mature sperm with HA receptors are distinguished from immature and abnormal sperm since these do not express such receptors.
Infertile couples may also resort to egg donation or embryo donation when the female partner cannot have genetic children because her own eggs cannot generate a viable pregnancy. Surrogacy via a gestational carrier is also an option when a patient's medical condition prevents a safe pregnancy, when a patient has ovaries but no uterus due to congenital absence or previous surgical removal, and where a patient has no ovaries and is also unable to carry a pregnancy to full term.
A disease of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
A condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble g
The loss of function of the ovaries before age 40.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
