HEALTHY HEART MATTERS

Cardiovascular diseases have been widespread in Bulgaria and the Covid-19 pandemic only made the situation worse. A woman, DR KRASIMIRA HRISTOVA, MD, PhD, FESC, is in the frontlines in fighting for better health. A cardiologist with over 25 years of experience, Dr Hristova is an Associated Professor of Cardiology. For years, she was an expert in echocardiography in National Heart Hospital. Today she is the Medical Director in Medical Center for Cardiovascular Diseases. Her scientific interests are in application of new echocardiography methods for evaluation of myocardial deformation in patients with acute myocardial infarct. 

She has specialised in Austria and Belgium, and is a board member of the International Hypertension League and director of its Eastern Europe branch. She is also the chairwoman of the Bulgarian Association of Cardiovascular Imaging and the founder of the Foundation of Cardiovasular Imaging, and is engaged in the organisation of international campaigns for prevention of cardiological diseases. 

How did the Covid-19 pandemic affect the Bulgarians' cardiovascular health?

The past 3 years transformed both the Bulgarian and the international healthcare systems. The fight to curb down the pandemic and to deal with urgent cases of coronavirus infected patients neglected the problems of the chronically ill. Emergency help resources were mainly dedicated to dealing with acute respiratory distress syndrome and acute lung, hearth and vessel thrombosis cases. Our chronically ill patients were scared that they could get Covid-19, which resulted in delays and changes in their treatment. Access to hospital care was difficult, therapies were cut down, and the condition of many sufferers from chronic heart failure, for example, deteriorated. This erased the benefits of years of treatment, now it is hard to reestablish control and stabilise them.

The slow vaccination process, which is still under 30% in Bulgaria, also significantly changed the picture of cardiovascular diseases. Many of our patients had asymptomatic Covid-19 that caused post-Covid complications. We are now seeing more people under 50 with acute coronary syndrome and more cases of metabolic syndrome and insulin resistance due to the lack of movement during the lockdown. This is a prerequisite for early atherosclerotic changes.

Getting Covid-19 also unlocks autoimmune processes and changes and aggravates the patients' metabolic profile. It also damages not only the lungs, but also the heart, the blood vessels, the brain, the kidneys, gastrointestinal and endocrine system.

Does hypertension remain a major health problem in Bulgaria?

Arterial hypertension does not affect Bulgaria only. It is still a challenge to treat such patients and lower their tension to 120/80 mmHg, the values set in the current Recommendations for Treatment of Arterial Hypertension. Just 30% of hypertension sufferers reach this target, and 30% of the population are not aware that they have arterial hypertension. People often underestimate possible symptoms such as headache and vertigo at the end of their workday. Having been ill with Covid-19 can also increase the arterial tension.

How did the Medical Center for Specialised Medical Help for Cardiovascular Diseases change in those years?

Almost 6 years have passed since we realised our dream to create such a place. The past years proved that we are needed not only as a treatment and prophylaxis centre that works with the most advanced diagnostic equipment by established manufacturers – about 90% of our equipment is the highest class of General Electric, a leader in ultrasound diagnosis. Nationally and internationally established professionals work at our centre. We are very successful in prophylaxis of cardiovascular problems and heart failure, of prevention and follow-up of patients with myocardial infarction, heart arrhythmia, arterial hypertension, and cardio-cerebral symptoms. We also established ourselves as a centre for training cardiologists on methods for highly specialised testing of cardiovascular diseases. Our courses that introduce colleagues to the new technologies that we use – such as myocardial deformation in echocardiography, 3D echocardiography, cardiopulmonary stress tests, telemedicine etc, have become a tradition. We constantly improve our equipment, all of our technology was made less than 3 years ago. We are the only centre in Bulgaria certified to perform cardiopulmonary stress tests by Harvard Medical School. We will soon be an accredited echocardiography centre by the European Association of Cardiovascular Imaging.

What, in your opinion, are the professional qualities of Bulgarian cardiologists? What have they achieved and what challenges they meet?

Creating experienced professionals is a long and complicated process that requires a lot of effort, energy, perseverance and constant perfection of one's knowledge and skills. This is why medical education takes longer and continues after graduation, with specialisation in a particular field. Good specialists have to work constantly and to know the theory in depth, so continuous education is a must. Cardiology is one the medical fields that have been significantly affected by new technologies for diagnosis and treatment. In the past years, in Bulgaria were successfully implemented some of the most advanced treatment methods – nonsurgical ones such as transcatheter implantation of an artificial valve and minimally invasive surgery that is more sparing than traditional one.

Why is the Foundation for Noninvasive Image Diagnosis important for doctors, patients and even healthy Bulgarians?

In the past few years, the foundation started educational modules for echocardiography, heart nuclear magnetic resonance and computer tomography for young and established cardiologists. This June, we were the golden sponsor of the Academy for Emergency Medicine for medicine students. We have started the Sofia Echocardiography Days, a traditional event that in 2 days allows our colleagues to learn more about the latest innovations in diagnosis of cardiovascular diseases. This March, with the support of the American Heart Association, we started a programme for cardiovascular prophylaxis for women. I want to thank Dr Nedelya Shtonova who became the campaign's brand ambassador. Of course, the pandemic significantly reduced the planned scale of the event.

What was the most interesting event on this year's Sofia Cardiography Days, that took place in April?

This year's event was dedicated to congenital and acquired valve conditions. Specialists from Germany, the US, the UK, France, Greece and Italy demonstrated the novelties in diagnosis and treatment of valve defects. For the first time we saw how AI can diagnose such problems and an exceptional presentation of application of intracardiac ultrasound (ICE) in transcatheter treatment of tricuspid regurgitation by Dr Mani Vannan, the US.

The event also includes practical trainings that are very popular among young cardiologists. For yet another year we gave them the opportunity to present interesting clinical cases from their practice and to discuss them with colleagues. Besides the traditional awards for participants in this session, for a second year in a row we also gave a big award for the best presented clinical case, in memory of the late Professor Maurizio Galderisi.

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