Causes and Controls of Chronic Illness - Research Paper Example

Cardiovascular Disease: Causes and Controls of the Chronic Illness Cardiovascular disease is a of disease ofcritical importance not only to medical practitioners but to patients and candidate patients as well. According to the World Health Organization, “Cardiovascular diseases are the leading causes of death and disability in the world. Although a large proportion of cardiovascular disease is preventable, they continue to rise mainly because preventive measures are inadequate.” In 2008, a total of 17.3 million people have died from cardiovascular disease while 80% of these deaths were observed in low and middle-income countries. It is estimated that around 23.6 million people will die from this type of disease by the year 2030 (Global Atlas on Cardiovascular Disease Prevention and Control). Because of the significant effect of cardiovascular disease to the health and well-being of a significant percentage of the population, the causes and controls of this illness is necessary to investigate and fathom. Cardiovascular disease refers to any ailment that implicates the cardiovascular system which is comprised of the heart and blood vessels including the arteries, veins and capillaries. This class of disease includes but not limited to coronary heart disease, also known as coronary or ischaemic heart disease, heart failure, hypertensive heart disease, cardiomyopathy, cardiac dysrhythmias, cor pulmonale, valvular heart disease, inflammatory heart disease, stroke, cerebrovascular disease and peripheral arterial disease (Kelly 74). Usually, patients are not aware that they are prone or already have the diseases of this nature until they undergo a thorough medical examination. According to Seizer (27), examples of symptoms that signal the patients to seek medical attention are “sudden loss of consciousness, severe dizziness or faintness, severe chest pain, severe shortness of breath, or sudden onset of rapid heart action.” Chronic symptoms of shortness of breath, palpitations and chest pains are also common reasons for patients to go to hospitals. Undiagnosed heart problems often lead the patients to feel abnormal shortness of breath even when there is no strenuous activity being done. This is brought about by dyspenea, or the diseases of the heart and lungs associated to damaged function of the left ventricle, which leads to hyperventilation. Palpitations deals with the sudden and unusual heart action at unprovoked circumstances, affecting the heart to beat at an irregular pace. This abnormality is called arrhythmia. On the other hand, chest pain is the main symptom of coronary disease. There are several causes of chest pains and most of them are not related to any abnormalities on heart functions therefore patients need to undergo further tests to correctly discern the underlying illness (Mackay, Mensah and Mendis). Aside from the principal symptoms that are directly associated with cardiovascular disease, physicians also look for patient and family medical history and perform physical examination such as cardiac auscultation or listening to the heartbeat by means of a stethoscope, determining the blood pressure, checking the arterial pulse and monitoring the venous pulse. Healthy individuals demonstrate two normal heart sounds courtesy of the heart valves action. Persons showing symptoms of heart disease reveals heart murmurs under cardiac auscultations. This condition is brought about by the rapid turbulence of blood flow as caused by the narrowing of a heart valve, backflow of blood due to unapt heart valve, or impairment on the functions of large blood vessels. The occurrence of heart murmurs may expose a congenital defect of the patient’s heart (Seizer 29). In addition, congestive heart failure is detected through physical examinations. Seizer (30) stated that “Serious malfunction of the heart may be signaled by abnormalities of the venous pulse in the neck, the presence of rales (bubbling noises during breathing), enlargement of the liver, and the accumulation of fluid in the ankles around the lungs and in the abdominal cavity.” Tests performed for patients to detect signs of cardiovascular disease are blood tests, chest X-ray, electrocardiography and treadmill stress tests. Heart problem may be existent when patients are observed with “abnormal heart sounds or murmurs, irregularities of the rhythm of the heart, elevated blood pressure, unusual shape or enlargement of the heart shadow in the X-ray film, abnormalities shown in the standard electrocardiogram, and electrocardiographic abnormalities detected during a treadmill stress test. Further assessment is recommended to confirm or discard the suspicion of heart disease from abnormalities revealed in the medical examination findings (Seizer 26). Electrocardiography is a noninvasive test using an amplifier called electrocardiograph to pick the weak current from the surface of the body. The image produced by electrocardiogram shows any deviation from the lines that symbolizes electrical activity. Normal electrocardiogram illustrates a series of evenly spaced complexes, while abnormal results will show deviations from the sequence of beat, denoting arrhythmias, and irregular waves and baseline segments. This test is essential in diagnosing cardiac arrhythmias because it demonstrates the direction, shape of waves and the rate and symmetry of heartbeats. The state of the heart muscles are also revealed by using this equipment. Still, careful interpretation of physicians are needed in performing electrocardiography since abnormal results does not guarantee to reveal heart disease conditions (Kelly 76-82). Moreover, other noninvasive tests such as blood tests, treadmill stress test, radiography, echocardiography and nuclear ventriculography, are utilized together with electrocardiogaphy. Three types of blood tests are accomplished in determining cardiac illnesses which include the “measurement of cardiac enzymes in acute myocardial infarction; measurement of cardiac drug levels in the blood to regulate dosage; and blood culture for discovery of bacteria if infection of the heart is suspected.” (Seizer 34). The treadmill stress test is used to monitor any coronary-artery disease related symptoms by gauging the impact of increased work on the heart as the patient use the treadmill. Radiography can show the enlargement of the blood vessels and the heart muscle, as well as the individual heart chambers. Cardiac radiography is beneficial in evaluating the changes upon the examination of heart enlargement and any chances of the occurrence of heart failure. Echocardiography is a form of ultrasound technique that produces images of the heart by illustrating the presence of backflow through heart valves that are incompetent. This device is also helpful in discovering the occurrence of congenital heart disease and evaluating the severity of stenosis or the narrowing of the cardiac valve. Nuclear ventriculography is used to record the movement of the cardiac chambers by making the blood radioactive temporarily through the injection of isotope into the bloodstream. This test can show if the entire ventricle is constricting (Seizer 32-35). Meanwhile, invasive tests are recommended to be performed depending on the seriousness of the patient condition such as cardiac catheterization, angiocardiography, coronary arteriography, left ventriculography and electrophysiological study. Patients undergo cardiac catheterization in order for doctors to diagnose pulmonary hypertension by assessing the function of the two ventricles during rest and strenuous activities. Intensive-care patients submit to hemodynamic monitoring, an application of cardiac catheterization, to observe the pressures on the pulmonary artery and erratic resolve of heart output. Angiocardiography refers to the difference if the heart and blood vessels in radiography. Coronary arteriography introduces catheters to into the large artery in the groin and travels to the aorta. Left ventriculography assesses the contractions of the left ventricle and measures the ejection fraction. Electrophysiological study deals with the introduction of wires to several areas of the cardiac muscle to note electrical potential from the inside of the heart (Seizer 36-45). The risk for cardiovascular disease is evaluated in hospitals by considering the patient’s age, gender, total blood cholesterol, presence or absence of diabetes, if the patient is a smoker or not and systolic blood pressure. Higher risk of cardiovascular disease is raised for patients exhibiting the following: “already on antihypertensive therapy; premature menopause; approaching the next age category or systolic blood pressure category; obesity; sedentary lifestyle; family history of premature cardiovascular disease or stroke in the first degree relative; raised triglyceride level; low cholesterol level; raised levels of C-reactive protein, fibrinogen, hemocysteine, apolipoprotein, or fasting glycemia or impaired glucose tolerance; microalbuminuria, raised pulse rate; and socioeconomic deprivation (World Health Organization and UNAIDS 8-9). Two of the most significant risk factors of cardiovascular disease are age and sex of the person. Based on a research by the World Health Organization, 87% of deaths caused by coronary heart disease are from adults at 60 years old and above and people at age 55 years old and above are twice as much to incur stroke than with younger adults. As people age, their level of serum cholesterol also increases and the arterial elasticity reduces, subjecting them to develop coronary artery disease. On the other hand, men are more prone to develop heart disease than women until the later reaches the menopausal stage. This factor may be attributed to hormonal differences between men and women, since the female hormone estrogen may be hindering the onslaught of coronary ailments by improving the function of endothelial cells (Mackay, Mensah and Mendis). In 1997, a study by Ridker, et al. (973) reveals that inflammation is another symptom that should be treated with outmost importance in comprehending the risk for cardiovascular disease, specifically atherothrombosis, in men. Results of the said research showed that inflammation increases the risk of having a first myocardial infarction and patients when treated with aspirin are least likely to suffer one. Furthermore, the function of the degree of obesity as an independent risk factor for cardiovascular diseases was reported by Hubert, et al, (968) stating that the incidence of experiencing angina, stroke, congestive failure, death and other coronary diseases in men and women increases as weight increases. Obesity is related to increased blood pressure, blood glucose and blood lipids and women are of greater risk on being obese as they age than men. The authors concluded that the data on the study “further indicate that intervention on the well-established risk factors for the disease should be accompanied by weight loss in the overweight individual.” (Hubert, et al. 976). Prevention for the possible manifestation of cardiovascular disease primarily stresses the importance of keeping a healthy lifestyle and obtaining necessary medical treatment for symptoms. On the guidelines set by the Centers for Disease Control and Prevention (Heart Disease: Prevention, What You Can Do), patients are recommended to eat a healthy diet, maintain a healthy weight, exercise regularly, avoid smoking and second-hand smoke and limit the use of alcohol. People are encouraged to eat a lot of fruits and vegetables, eat food with low saturated fat and cholesterol, limit sodium and eat food with high fiber content. High blood cholesterol can be prevented by limiting saturated fat, while blood pressure can be lowered by taking less salt on the daily food intake of patients. Regular physical activity of at least 30 minutes at three times a week also benefits the patient not only by decreasing the chance of being obese, but by lowering the cholesterol level and blood pressure as well. Smoking is considered as one of the top causes of heart disease. Reducing cigarette intake, if not avoiding it completely can significantly decrease the risk of coronary disease. Moderate alcohol consumption is allowed within the recommended daily limits of consuming one to two alcoholic drinks per day. Excessive intake of alcohol units may increase the risk of cardiovascular disease. The regular intake of fruits and vegetables has been proven to reduce the risk of cardiovascular disease in women especially when they are consumed in large amounts. At least five servings of fruit and vegetables every day is recommended to efficiently receive the nourishments found in these food groups such as “beneficial combinations of micronutrients, antioxidants, phytochemicals, and fiber” (Liu, et. al. 922). Findings also show that reduced intakes of animal products combined with high consumption of fruits and vegetables lessen the chance of contracting coronary disease (Liu, et. al. 927). More so, the effects of high intakes of Vitamin E from either natural diet or synthetic supplements in the primary prevention of cardiovascular disease as well as cancer were explored by Lee, at. al. (56) in 2005. Research trials showed that the risk of developing cardiovascular disease such as nonfatal stroke, nonfatal myocardial infarction and death, and cancer on healthy women decreased when the subjects administer 600 IU of natural source vitamin E every day. This phenomenon can be attributed to the antioxidant properties of Vitamin E which includes “inhibition of oxidation of low-density lipoprotein cholesterol in plasma, leading to the hypothesis that it can prevent this chronic disease.” (Lee, et. al. 57). Regular exercise has been established as a vital prevention method in developing the disease as Blair, et al (208) studied the influences of cardiorespiratory fitness on cardiovascular disease mortality in men and women. According to the results, Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality. The research also exposes the observation that fit persons still have lower risk of mortality from cardiovascular disease even when they submit to smoking or obtain high blood pressure or high cholesterol level. Patients diagnosed of high cholesterol, high blood pressure and diabetes are all candidates of future heart conditions. Medical practitioners advise these high risk people to have their cholesterol and blood pressure checked regularly, manage their diabetes, continue medication as per doctor advice, and always discuss the treatment plan with their doctors (Heart Disease: Prevention, What You Can Do). The administration of aspirin to control existing cardiovascular disease is another recommendation that is widely accepted. According to the Centers for Disease Control and Prevention (Heart Disease: Recommendations of Aspirin for Prevention of Cardiovascular Disease), “Aspirin can be beneficial to individuals who already have experienced a heart attack, stroke, angina or peripheral vascular disease, or have had certain procedures such as angioplasty or bypass. Doctors recommend aspirin use for persons with these conditions unless there is another medical reason why these individuals should not take aspirin.” Sometimes doctors advise patients to take aspirin together with other anti-platelet drugs to accommodate a more effective therapy method. In addition, using aspirin is also endorsed as a method to prevent the future occurrence of heart disease and stroke. Data obtained by the U.S. Preventive Services Task Force showed that “men with no history of heart disease or stroke aged 45-79 years use aspirin to prevent myocardial infarctions and that women with no history of heart disease or stroke aged 55-79 use aspirin to prevent stroke when the benefit of aspirin use outweighs the potential harm of gastrointestinal hemorrhage or other serious bleeding.” (Heart Disease: Recommendations of Aspirin for Prevention of Cardiovascular Disease). As always, the organization recommends that patients must first speak with a healthcare professional before taking any medication. The capacity of aspirin in reducing the risk of heart disease significantly was supported by the research of Ridker, et. al. (978), reporting a 55.7% reduction in the risk of developing myocardial infarction in men. Advance treatments for high risk patients with cardiovascular disease by combining different medicines such as statins, aspirins and beta blockers were discovered by Hippisley-Cox and Coupland (1060) in the United Kingdom. Although statins are known to improve the condition of ischaemic heart disease patients, there are no concrete studies to claim the effect of combined medications with statin. Authors found out that the combination of such drugs improve the survival rate of the said patients, however adding an angiotensin converting enzyme inhibitor does not do anything to the effect of the treatment. The American Heart Association added the physician-patient partnership on its recommendation for the prevention of cardiovascular disease. According to the scientific statement that the organization released in 2002, “A physician-patient partnership must be forged, on the physician’s part by assessing and communicating risk and by co-developing with the patient a plan of preventive action.” (Pearson, et al. 390). Tools for healthcare providers were supplied by the association to support the said program. However, the American Heart Association recognize the difficulty of healthcare professionals to engage several patients on this program during the earlier stage of their illness so they advise to the creation of an environment that is supportive for changes in risk factors, particularly long term assistances of adherence to medical and lifestyle interventions. Nevertheless, knowing the reasons behind the existence of cardiovascular disease, its diagnosis, treatment and prevention is important in understanding the illness and its impact to first time patients and high risk patients. Since cardiovascular disease involves numerous parts of the human body that are critical to its functioning ability and does not have an absolute cure, regular medical examination and healthy living are endorsed to prevent the risk of contracting this disease. Works Cited Blair, S.N., Kampert, J.B., Kohl, H.W., Barlow, C.E., Macera, C.A., Paffenbarger, R.S. & Gibbons, L.W. “Influences of Cardiorespiratory Fitness and Other Precursors on Cardiovascular Disease and All-Cause Mortality in Men and Women”. The Journal of the American Medical Association. 276.3 (1996): 205-210. Print. Cox, J.H. and Coupland, C. “Effect of Combinations of Drugs on All Cause Mortality in Patients with Ischaemic Heart Disease: Nested Case-Control Analysis”. Bureau of Medical Journal. 330.7499 (2005): 1059-1063. Print. “Global Atlas on Cardiovascular Disease Prevention and Control”. World Health Organization. n.d. 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