# Immunity-diseases of the circulatory System #
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Immunity-associated diseases of the cardiovascular system: Pathomechanisms and clinical relevance
The circulatory System functions assigned to the supply of the organs with oxygen and nutrients and removal of metabolic waste products are for Survival is essential. In the last decades has shown that a number of diseases of this system are determined not only by conventional risk factors such as hypertension, hyperlipidemia, or Diabetes mellitus, but also by immunological processes are affected.
Immune-mediated cardiovascular diseases include a heterogeneous group of diseases in which dysregulation of the immune system leads to an inflammatory response against the body's own structures. Among the most important categories:
Rheumatic heart disease, in particular Streptococcus pyogenes infection, occurring in rheumatic fever with the following cardiac involvement (Endo‑, Myo‑ or pericarditis). Here, the phenomenon of molecular Mimikrie plays a Central role: antibodies against bacterial antigens react gewebsstrukturen cross with a Heart.
Vasculitis, i.e., inflammation of the blood vessel walls. Systemic vasculitis such as Granulomatosis with Polyangiitis (GPA, formerly Wegener's Granulomatosis) or Polyarteritis nodosa may affect the coronary arteries or other vessels of the circulatory system and lead to Ischemia, Infarction, or aneurysms.
Autoimmune‑associated cardiomyopathies, such as dilated cardiomyopathy with proven autoantibodies against the cardiac muscle proteins (such as β‑Adrenoceptors, or Myosin).
Atherosclerosis as a chronic inflammatory disease. Meanwhile, atherosclerosis is considered as a purely degenerative process, but rather as a complex process with a crucial involvement of the immune system. Macrophages, T‑lymphocytes and inflammatory cytokines (e.g., TNF‑α, IL‑6) play an important role in Plaque formation and instability.
Pathophysiological Mechanisms
The common basis of many immune-associated cardiovascular diseases, there is a Dysregulation of the immune response is:
Activation of the Inflammasome leads to the release of proinflammatory cytokines and initiates chronic inflammation in the vascular endothelium or the heart muscle.
The formation of auto-antibodies against the body's own antigens (e.g., against phospholipids in the case of Antiphospholipid syndrome) may cause thrombus formation and Vascular occlusion.
T‑cell‑mediated tissue damage occurs in myocardial inflammation, if the author of attack of active T‑cells, heart muscle cells.
Immune complex deposits in the vascular wall (e.g., systemic Lupus erythematosus) can activate the complement system and cause a vasculitis.
Clinical implications and therapeutic approaches
The diagnostics includes, besides the classical cardiovascular examination (ECG, echocardiography, coronary angiography) also immunological Tests:
Determination of autoantibodies (ANA, ANCA, Anti‑Myosin antibody)
Measurement of markers of Inflammation (CRP, ESR, IL‑6)
Tissue biopsy in vasculitic conditions for histological confirmation
The therapy depends on the disease and aims to attenuate the immunological Hyperactivity:
Corticosteroids (prednisone) as a basic medication to suppress the inflammation.
Immunosuppressants, such as methotrexate, azathioprine or Mycophenolate mofetil for the reduction of the autoimmune reaction.
Biologics (e.g., Anti‑TNF‑α antibody, Rituximab) for treatment-resistant forms.
Adjuvant cardiovascular medications (beta blockers, ACE inhibitors, anticoagulants) to support the heart function, and thrombosis prophylaxis.
Summary
Immunity-associated cardiovascular diseases represent a major challenge for clinical medicine. A deeper understanding of the immunopathological mechanisms allows the development of targeted therapies and may improve the prognosis of this group of patients significantly. The close cooperation between cardiologists and rheumatologists/immunologists is of Central importance.
## Pain in diseases of the cardiovascular System ##
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