Cardiovascular Disease - Essay Example

Cardio vascular disease has been defined as "impairment of heart function due to inadequate blood flow to the heart compared to its needs, caused by obstructive changes in the coronary circulation to the heart". It is the cause of 20 to 30 percent of deaths in most industrialized countries. The WHO has drawn attention to the fact that CVD or coronary artery disease is our "modern epidemic". The disease has many manifestations - angina pectoris of effort, myocardial infarction, irregularities of the heart, cardiac failure and even sudden death. Rheumatic heart disease and cardiomyopathy are potential sources of diagnostic confusion. Cardiovascular Disease (CVD) includes dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining areas of the body like the brain, the heart itself, and other vital organs. Hinderence in oxygen supply eventually results in death of the tissue or organ. Ischemic Heart Disease is the technical term for obstruction of blood flow to the heart. This, most commonly results due to narrowing of veins due to excess fat or plaque deposits . Excess buildups of fat or plaque are respectively termed arteriosclerosis and atherosclerosis. Equally significant is stroke which is caused by inadequate oxygen supply to the brain. Hypertension or high blood pressure often results from this excess fat or plaque buildup because of the extra effort it takes to circulate blood. Even though the heart works harder, blockages still shortchange the needed blood supply to all areas of the body. The. High blood pressure is called "The Silent Killer" because the first warning sign is an angina attack or a deadly heart attack or a stroke. Kidney disorders (which leave extra fluids, sodium, and toxins in the body), obesity, diabetes, birth control pills, pregnancy, smoking, excess alcohol, stress, and thyroid and adrenal gland problems can also cause and exacerbate a rise in blood pressure. Damage to the heart tissues from CVD or from heart surgery disrupts the natural electrical impulses of the heart and results in cardiac arrhythmia (an abnormally high or abnormally low heart rate). Individuals often don't realize the aftermath and side effects that invasive surgical procedures leave. Sudden fluctuations in heart rate can cause noticeable palpitations, which may be associated with faintness, or dizziness, and if severely abnormal it could interfere with blood flow and even initiate a heart attack. Maintaining proper levels of blood cholesterol is also important in the prevention of heart attack or stroke. Total blood cholesterol above 200 mg/dl, LDL cholesterol above 130 mg/dl, HDL cholesterol below 35 mg/dl; and lipoprotein(a) level greater than 30 mg/dl are indicators of problematic cholesterol. Cholesterol is not actually a damage mechanism but is actually an indicator of compromised liver function, and increased risk of heart attack Infections of the heart such as carditis and endocarditis are an additional complication that may result from a weak immune system, liver problems, heart surgery or autoimmune disorders like rheumatic fever. If not appropriately treated, infections can cause permanent damage to the cardiac muscles. Risk factors: The etiology of CHD is multifactorial. Apart from the obvious ones such as increasing age and male sex, there are other several important "risk" factors out of which some are modifiable which include age, sex, family history, genetic factors and personality traits. Others are immutable factors which include cigarette smoking, high blood pressure, hypercholesterolemia, diabetes, obesity, sedentary lifestyle and stress. Smoking: Some people commit sucide by drowning ,but many by smoking. A uniquely human habit ,smoking has been identified as a major CHD risk factor with several possible mechanisms-carbon monoxide induced atherogenesis ; nicotine stimulation of adregenic drive raising both blood pressure and myocardial oxygen demand ; lipid metabolism with fall in protective high density lipoprotein .there is evidence that the influence of smoking is not only independent of ,but also synergist with other risk factors such as hypertension and elevated serum cholesterol . the risk of death from CHD decreases on cessation of smoking Hypertension The blood pressure is the single most useful test for identifying individuals at a risk of developing CHD .hypertension accelerates the atherosclerotic process ,specially if hyperlipidemia is also present and contributes importantly to CHD Serum cholesterol Elevation of serum cholesterol is one of the factors which carries a increased risk of the development of myocardial infarction .when we look at the various types of lipoproteins the low-density lipoprotein (LDL) cholesterol that is most directly associated with CHD whereas high density lipoprotein cholesterol is protectiveagainst the development of CHD . Other risk factors : (i) Diabetes : the risk of CHD increases 2-3 times in diabetics (ii) Genetic factors : a family history is known to increase the risk factors of premature death . (iii) Physical activity :sedentary life style is associated with a greater risk of the development of early CHD (iv) Hormones: pronounced difference of the mortality rates for CHD between male and female subjects suggest that the underline may have a hormonal basis . (v) Alcohol: hih alcohol intake defined as 75gms or more per day is an independent risk factor for CHD ,hypertension and all cardiovascular disease (vi) Oral contraceptives : women using oral contraceptives have systolic and diastolic blood pressure seem to be at a higher risk of myocardial infarction. Symptoms: If the plaque narrows the lumen or channel of the artery, it may make it significantly cuts down the quantities of blood to flow to the heart muscle. If the build-up reduces flow only mildly, there may be no noticeable symptoms at rest, but symptoms such as chest pressure may occur with increased physical activity or stress. These are signals that cardiac muscle function is not proper. Other symptoms that may be experienced are heartburn, nausea, vomiting, shortness of breath, and heavy sweating. When flow is drastically reduced and the heart muscle does not receive enough blood flow to meet its needs (cardiac ischemia), severe symptoms such as chest pain (angina pectoris), heart attack (myocardial infarction), or rhythm disturbances (arrhythmias) may occur. A heart attack is the result of a completely blocked artery which damages the heart muscle Diagnostic tests: If a patient is suspected to have coronary artery disease has symptoms of the disease, several tests have to be used to make a complete diagnosis. Initial tests may include an electrocardiogram (ECG) while a patient is resting, and again while walking or running on a treadmill or pedaling a stationary bicycle. If this test indicates that the heart is not getting the oxygen it needs, cardiac catheterization, also called an "angiogram," may be performed. By using a catheter (small, hollow tube) to inject x-ray dye (contrast) into the coronary arteries, x-ray movies of the coronary arteries can be obtained. These x-ray movies allow the doctor to see any narrowing in coronary arteries and determine their severity. Using the information gathered from one or more of these tests, the doctor is better able to decide the best treatment plan. Treatment options: The traditional approach is medication and surgery, but several published studies indicate that a second and even third opinion should be obtained before proceeding with surgery. There are three basic ways to treat atherosclerotic disease: medication, surgery, and minimally invasive interventional procedures such as stent implantation, percutaneous transluminal coronary angioplasty (PTCA), atherectomy, and excimer laser therapy. The purpose of these treatments is to eliminate or reduce the symptoms and, in the case of coronary artery disease, decrease the risk of heart attack. Medications can be used by themselves or in combination with one of the treatments. While medications do not eliminate the narrowing of arteries, they can help improve the efficiency of the heart and relieve symptoms such as chest pain (angina), leg pain, claudication, and hypertension. Angiograms, bypass surgery, and angioplasty are expensive , physically invasive and traumatic for the heart patient, and upon evaluation of case histories has been shown to be five to ten times more deadly than the disease, and in many instances unnecessary Many scientific studies validate the effect diet and supplements can have for the body to heal damages to the cardiovascular system. Lifestyle changes can also make a big difference. Restenosis is a post -operative re-narrowing of the blood vessel due to the growth of tissue at the site of the angioplasty or stunt implantation. This re-narrowing of the blood vessel may lead to the return of symptoms associated with coronary artery disease. Restenosis occurs in a significant portion of angioplasty patients within months after treatment. Some patients are more predisposed to experience restenosis than others. A patient may have already developed restenosis or may be at a high risk of developing ones. Management options should be carefully weighed keeping an individuals risk factors in mind. Measuring the burden of the disease: The burden of the a disease of CHD may be estimated by various methods a) proportional mortality ratio : this is the simplest measure and refers to the proportion of all deaths currently attributed to a disease . for example CHD is held responsible for about 30% of deaths in men and 25% of deaths in women in most western countries b) loss of life expectancy : CHD cuts short the life expectancy calculations have been made for the average gain in life expectation that would follow a complete elimination of all cardiovascular deaths if other mortality rates remain unchanged . the benefit would range for men from 3.4years to 9.4 years and even greater for women c) CHD incidence rate : this the sum of fatal and non fatal attack rates because of its different manifestations accurate incidence of CHD rates are difficult to compute . mortality rates can be used as a crude indicator of incidence d) Age specific death rates: when analysis is planned to throw light on etiology it is essential to study the age specific rates. Age specific death rates suggest a true increase in incidence. e) Prevalence rate: prevalence of CHD can be estimated from cross sectional surveys using ECG for evidence of infarction and history of prolonged chest pain. f) Case fatality rate: this is defined as the proportion of attacks that are fatal within 28 days of onset. REFRENCES Epidemiology of Chronic Non-Communicable Disease and Condition: Textbook Of Preventive and Social Epidemiology 6:271-276. http://www.mayoclinic.com/health/cardiovascular-disease/HB00032. http://www.who.int/cardiovascular_diseases/en/ http://www.wrongdiagnosis.com/c/cardiovascular_diseases/intro.htm http://www.cdc.gov/cvh/ Read More