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Assoc. Prof. Dr Krasimira Hristova Assoc. Prof. Dr Krasimira Hristova

Assoc. Prof. Dr Krasimira Hristova from National Heart Hospital on how to keep your heart fit and healthy

Timely and professional diagnosis is crucial for treatment of cardiovascular diseases and the latest development in the field are putting the stress on non-invasive methods like echocardiography, stress echocardiography and Holter monitoring. The National Heart Hospital in Sofia is one of the largest of its kind in the Balkans and is a place where competent healthcare performed by dedicated and professional staff is matched by modern equipment for non-invasive diagnostics.

The head of the Medical Center for Cardiovascular Diseases and Associated Professor of Cardiology in Department of Noninvasive Functional Diagnostics and Imaging in National Heart Hospital is Assoc. Prof. Dr Krasimira Hristova, MD, PhD, FESC with significant experience in the field. Her scientific research has focused on application of new echocardiography methods for evaluation of myocardial deformations in patients with acute myocardial infarction. She has specialised in Austria and Belgium, and is a Member of Board of Directors of the International Hypertension League, Member of Scientific Committee of American Society of Echocardiography and European Association of Cardiovascular Imaging and a chairman of the Foundation of Noninvasive Cardiovascular Imaging.

To what extent cardiovascular diseases affect people in Bulgaria?

In the past 2-3 years there has been a stable trend for reduction of the cardiovascular diseases, but sadly we are now experiencing a growing number of cerebrovascular diseases. Bulgaria is among the countries in the world with highest rates of cardiovascular diseases, and in 2012 the country ranked first in the EU in this regard.

A number of factors are the reason for this. On one hand, is the unhealthy lifestyle and eating habits, and the stress. On the other hand is the lack of prophylaxis. Bulgaria spent a lot on prophylaxis in the past few years, and yet there are still many people who are unaware of their blood pressure values, the number of lipids in their blood, or even if they have diabetes. The lipids, the high blood pressure and the diabetes are all among the risk factors causing mortality from cardiovascular diseases. Overweight, increasingly so among women, is another problem threatening the Europeans. It is also influenced by the eating habits and the lifestyle, as well by the increased hormone intake in the past few years. An ongoing global study by the World Hypertension League that included 8,000,000 people from all over the world showed that a lot of people are unaware that they have high arterial blood pressure.

How can we recognise if we suffer from hypertension?

Hypertension, or high blood pressure, is a quiet disease. If the patient doesn't experience symptoms like headache and dizziness, and if he never checks his blood pressure at home, he can never think about consulting a doctor about this. It is also important to know that the values of the arterial blood pressure of a given individual change with the ageing: a patient who in his youth used to have low blood pressure, can develop hypertension in older age. In the past few years, with the general increase of the age of childbirth, hypertension has been increasingly affecting women. Pregnant women over 35 years of age experience high blood pressure more frequently than younger women who are expecting a child. Another factor for developing hypertension is hereditary predisposition. That is why the patient should know if his parents or other relative are suffering from it, and after a particular age he should be very careful to watch out his blood pressure.

How can we learn to live with hypertension?

Hypertension is an illness for life, but it can be controlled with medicines. At the moment on the market we have drugs combining 2-3 medicines, so a single pill a day can control the high blood pressure values for 24 hours. Some patients suffer from the so-called white coat syndrome - their values are normal until they enter the doctor's office, when they rocket. To avoid mistreatment in such cases, the patient is advised to undergo a 24-hour monitoring of the arterial blood pressure in his living environment, to minimise the stress that the very presence of a doctor or other medical staff can cause.

What is non-invasive cardiac diagnostics and what are its advantages?

In the past few years there have been an intensive discussion on the methodology for non-invasive analysis of the heart, which helps us to avoid needless invasive examinations like coronarography performed solely to establish the condition of the patient's vessels. This method can be replaced with a non-invasive one like echocardiography, Tissue Doppler echocardiography, Speckle Tracking Echocardiography, 3D echocardiography, cardiac magnetic resonance imaging or computer tomography. Last but not least are the 24-hour outpatient examinations of blood pressure studying and heart rhythm, and the increasingly popular telemedicine, which allows monitoring for 7 to 14 or 20 days of the patient's rhythm via a technology resembling a patch that is attached to his body. It collects all the information needed for analysis.

Another strong point of non-invasive diagnostics is that it can be performed in the outpatient clinic.

What of these methods do you apply in your practice in the National Heart Hospital?

We use all of those that I talked about. By this October, we will also acquire testing equipment for patients with sleep apnea which allows diagnosis on the outpatient stage of treatment, without hospitalisation.

Telemonitoring in our centre also has Holters for follow-up of heart rhythm more from 24 hours.

How can we minimise the risks of developing a cardiovascular disease?

Taking care for your health should start from an early age. Young people should be encouraged to keep healthy weight and to stay physically active, as sports and physical exercise are a natural barrier before high cholesterol and high arterial blood pressure. Men after 45 years of age and women after 50 years of age should have their blood tested for its lipid, blood sugar and cholesterol levels. When hypertension appears, echocardiography and Holter examination of the arterial pressure are a must, together with an examination of the eye fundi. These examinations take only 1-2 days and ensure the patient that in the following 5 years the risk of developing a cardiovascular incident is quite small.

Young patients with no particular problem can have prophylaxis each 2-3 years. Patients with diseases like diabetes and dyslipidemia should visit a specialist each year, and those treating hypertension with combined medicines should pay a visit before the summer and winter season, as their therapy should be adjusted to them.

How does cold weather affect cardiovascular diseases?

Low temperatures are a risk factor, as they narrow the coronary vessels thus increasing the risk of hypertension, pain, tightness in the chest, worsening of the cardiovascular disease.

The National Heart Hospital pays special attention to prophylaxis of children with cardiovascular diseases. Tell us more about this.

Early diagnostics is crucial in our work. We have now entered a stage when we deal with congenital valvular defects in adults, due to the fact that the children we successfully treated 10-15 years ago, have now grown up. So the number of patient with the disease is growing. About 15-20 years ago rheumatoid defects due to low-quality prophylaxis of rheumatism and its effect on the heart valves used to be quite numerous. This group is growing larger, partially because of better early diagnostics, and partially because of timely surgical intervention that results in more patients who survive their disease. We are also capable of following up their disease better. Having this in mind, yearly following of those patients with an echocardiography and Holter monitoring of the heart rhythm is an absolute must, as these patients can develop cardiovascular problems after their surgeries.

You are the chairman of the Foundation of Cardiovascular Imaging. What is the foundation's goals and activities?

The foundation's main goal is to inspire our colleagues, particularly the young ones, to be better informed on the opportunities that cardiovascular imaging gives, to work and know more, to be competent and equal to their colleagues in the West. Modern technology is crucial. The modern cardiologist cannot diagnose the patient only with his stethoscope and a ECG. He needs to be fluent in all the functional, non-invasive diagnostic methods available.

To achieve this, we organise the yearly Sofia Echocardiography Days. They are usually targeted to both adult and children cardiology specialists, and the lecturers are some of the finest professionals in the world. Our next event is taking place between 30 March and 1 April 2017, its topic are cardiomyopathies, which covers a large number of diseases. The main lecturers will be from the UK, France, Germany and from the USA. The big award for one of the participants is a 3-month free training in non-invasive diagnostics in the University of Leuven, Belgium.

National Heart Hospital, Sofia
Medical Center for Cardiovascular diseases
mobile: +359 888 871 353; +359 884 843 535; +359 889 597 655; +359 884 835 354


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