HEART DISEASE

ANIEKPENO SUNDAY UDUAK AND SUNDAY OLAJIDE AWOFISAYO

Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of uyo, Nigeria.

CORRESPONDENCE;

ANIEKPENO SUNDAY UDUAK

Email:[email protected];

Telephone: 08177099182

ABSTRACT

The heart is the organ that pumps blood throughout the body via the circulatory system. It is an essential and vital organ as it supplies blood to the different tissues and organs. Heart disease describes a range of pathological conditions that affect the heart. Diseases under this umbrella include blood vessel disease such as coronary artery disease and organ-based conditions such as arrhythmias and congenital heart defects. There has been an increase in death tools related to cardiovascular causes as shown by the Federal Ministry of Health revealing 11% of over 2 million non – communicable disease deaths in Nigeria annually. This increase is as a result of changes in life style patterns examples are smoking, drinking, lack of awareness and ignorance, traditional believes, inappropriate dieting and nutrition. These trends have contributed greatly to an increase in heart disease. The objective of this paper was to create awareness of some heart diseases, treatment plan and changes in lifestyle pattern that can reduce the risk of heart diseases.

INTRODUCTION

Heart disease describes a range of conditions that affects the heart. It is a term covering any disorder of the heart. Unlike cardiovascular disease, which describes problems with the blood vessels and circulatory system as well as the heart, heart disease refers to issues and deformities in the heart itself. According to the Centers of Disease Control (CDC), heart disease is the leading cause of death in the United Kingdom, United States, Canada and Australia. Heart disease encompasses a wide range of cardiovascular problems. It is also the leading cause of death for several populations including Caucasians, hispanics and African – Americans. Almost half of Americans are at risk for heart disease and the numbers are rising.

There are many types of heart disease and each one has its own symptoms and treatment. For some, lifestyle changes and medication can make a huge difference in improving the heart. Diseases under the heart disease umbrella include blood vessel diseases such as  coronary artery disease, heart rhythm problems (arrhythmias); and heart defects present at birth (congenital heart defects); arteries hardening (artherosclerosis); weakened and hardened heart muscles (cardiomyopathy). In the United States, one in every four deaths has been reported to be as a result of a heart disease. That is about 610,000 people who die from the condition each year.

Heart disease costs the United states about $219 billion each year from 2014 t0 2015. This includes the cost of health care services, medicines and lost productivity due to death. Coronary heart disease is the most common type of heart disease responsible for 365,914 deaths (about 6.7% people) in 2017. About 18.2million adults age 20 and older have coronary artery disease (CAD). About 2 in 10 deaths from CAD happen in adults less than 65years old. Every year, about 805,000 Americans have a first heart attack. 200,000 happen to people who have already had a heart attack   and about 1 in 5 heart attacks are silent. The damage is done, but the person is not aware of it. High blood pressure cholesterol and smoking are the key risk factors for heart disease. About half of Americans (47%) have at least one of these three risk factors.

COMPLICATIONS

Heart disease complications develop when the heart is getting less blood than it needs. This often occurs when plaque blocks blood vessels. Some of these heart complications include angina, a chest pain caused by heart disease. This is not the same as a heart attack, but can be a warning sign. It can also limit ones activity and lifestyle. Angina feels like a squeezing pressure in the chest. One may also feel pain in the neck, shoulder or jaw. Stable angina is the most common type. It occurs when the heart works harder than usual, that is stress or physical activity can trigger stable angina. Another like angina is atrial fibrillation, an abnormal heartbeat. It might come and go. The heart may beat rapidly and in an irregular patter. Symptoms of artrial fibrillation are; shortness of breath, palpitations and weakness. Arterial fibrillation increases ones chance of having a stroke due to blood clots which may form in the heart during artrial fibrillation.  The clots can then leave the heart and block blood flowing to the brain. Treatment may include medication, coronary artery bypass surgery and other operations to help control heart rate and rhythm.

Cardiac arrest is not the same as a heart attack. The heart actually stops beating during cardiac arrest. The victim would have no pulse that is, no blood would flow to the brain and other organs. Cardiac arrest causes a person to pass out within seconds!  If one is suffering from this, the emergency unit should be called right away. Next, the hands only cardiopulmonary resuscitation should be done. This can reverse cardiac arrest if started right away. Also an automated external defibrillator should be used if available.

Heart attack occurs when a coronary artery becomes so blocked that blood cannot reach part of the heart muscle. One may have very bad chest pain, cold sweats and trouble breathing. A heart attack can occur suddenly or get slowly worse over many hours. The heart does not stop beating during a heart attack. Early emergency treatment is the key to preventing severe heart damages.

Heart failure can lead to a gradual weakening of the heart. As the heart weakens, it has a harder time pumping blood out to the body. This causes blood to back up into the lungs. Also, fluid begins to build up in other parts of the body. Heart failure is one of the main reasons people are admitted to a hospital. It is also leading cause of death of people older than 60. Symptoms may include; shortness of breath, swelling of the ankles, wheezing and fatigue. Once heart failure starts, it is not reversible. However, treatment with medicine and lifestyle changes can help. Heart transplant surgery may be an option if treatment is not working.

Pulmonary Edema causes fluid to fill up the lungs. Heart failure is the most common cause of pulmonary edema. The heart is weak and cannot pump blood like it should. So, blood backs up into the blood vessels in the lungs that cause fluid to leak out. Symptoms include; extreme shortness of breath, chest pain, blue nails and lips, coughing that produces a small amount of blood. Pulmonary Edema is a medical emergency which could be treated with medication to lower blood pressure and reduce fluid.

Stroke refers to an ischemic stroke also called cerebral embolism. This means a blood clot formed in the heart then broke free and travelled to the brain. Once a clot lodges in the brain, it cuts off the blood supply. This causes a stroke. Common signs are sudden weakness on one side of the body, a dropping face and difficulty in speaking. Severe brain damage that occurs from circulatory arrest is caused mainly by permanent blockage of blood vessels by blood clots, thus leading to prolonged ischemia and eventually death of the neurons. Stroke is a medical emergency.

DIAGNOSIS

Most screening tests for heart disease are done outside of the body, any of these tests can be used for diagnosis:

Electrocardiogram

(ECG or EKG) makes a graph of the heart’s electrical activity as it beats. This test can show abnormal heartbeats, heart muscle damage, blood flow problems in the coronary arteries, and heart enlargement.

Stress test

Stress test or treadmill test or exercise ECG records the heart’s electrical activity during exercise, usually on a treadmill or exercise bike. If anyone is unable to exercise due to arthritis or other health conditions, a stress test can be done without exercise. Instead, a medicine that increases blood flow to the heart muscle and shows whether there are any problems in that flow is administered.

Nuclear scan (or thallium stress test)

This shows the working of the heart muscle as blood flows through the heart. A small amount of radioactive material is injected into the vein, usually in the arm, and a camera records how much is taken up by the heart muscles.

Echocardiography

Echocardiography changes sound waves into pictures that show the heart’s size, shape, and movement. The sound waves also can be used to see how much blood is pumped out by the heart when it contracts.

Coronary angiography (or angiogram or arteriography)

This shows an x ray of blood flow problems and blockages in the coronary arteries. A thin, flexible tube called a catheter is threaded through an artery of an arm or leg up into the heart. A dye is then injected into the

tube. This allows the heart and blood vessels to be filmed as the heart pumps. The picture is called an angiogram or arteriogram.

Ventriculogram is frequently a part of the x-ray dye test described before. It is used to get a picture of the heart’s main pumping chamber, typically the left ventricle.

Intracoronary ultrasound

Intracoronary ultrasound uses a catheter that measures blood flow. It creates a picture of the coronary arteries that shows the thickness and other features of the artery wall. This lets the doctor see blood flow and any blockages.

In addition, several new, highly sensitive screening tests have been developed.

Carotid doppler ultrasound

This uses sound waves to detect blockages and narrowing of the carotid artery in the neck, both of which can signal an increased risk for heart attack or stroke.

Electron-beam computed tomography

This is a superfast scan that provides a snapshot of the calcium buildup in your coronary arteries.

 Magnetic resonance imaging (MRI)

This is a scan using magnets and computers to create high-quality images of the heart’s structure and functioning. It is often used to evaluate congenital heart disease. The test can also detect severe blockages in coronary arteries in people who are having unstable angina or a heart attack, thereby allowing immediate treatment to restore blood flow to the heart.

 

TREATMENT AND MODE OF ACTION OF DRUG

The treatment of heart diseases depends on the pathophysiology and extent of progression of the disease.

Medications

Some medications may be used to treat a risk factor for heart disease complications, such as high blood pressure or high blood cholesterol. Others may be prescribed to prevent or relieve the symptoms of heart disease. It’s important to keep up a heart healthy lifestyle because healthy daily habits will keep the dose of medication as low as possible. Medications that are used include;

ACE inhibitors

 Stop’s the body from producing a chemical that narrows blood vessels. They are used to treat high blood pressure and damaged heart muscle. ACE inhibitors may reduce the risks of a future heart attack and heart failure. They also can prevent kidney damage in some people with diabetes. A common ACE inhibitor is lisinopril.

Mode of action

Lisinopril  is a peptidly-dipepetidase inhibitor. It inhibits the angiotensin converting enzyme [ACE] that catalyses the conversion of angiotensin [I] to the vasoconstrictor pepticle, angiotensin[II]. Angiotensin [II] also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE results in decreased concentration of angiotensin [ii] which results in decreased vasopressor activity and reduced aldosterone secretion. The decrease may result in an increase in serum potassium concentration.

SIDE EFFECT

Headache, dizziness, persistence cough, low blood pressure, chest pain.

Anticoagulants

Decrease the ability of the blood to clot, and therefore help to prevent clots from forming in your arteries and blocking blood flow. These medicines are sometimes called blood thinners, though they do not actually thin the blood. Anticoagulants do not dissolve clots that have already formed, but they may prevent the clots from becoming larger and causing more serious problems, an example is heparin.

Antiplatelets

Antiplatelets are medications that stop blood particles called platelets from clumping together to form harmful clots. These medications may be given to people who have had a heart attack, have angina, or who experience chest pain after an angioplasty procedure example is aspirin.

Beta blockers

Beta blockers slow the heart rate and allow it to beat with less force. They are used to treat high blood pressure and some arrhythmias (abnormal heart rhythms), and to prevent a repeat heart attack. They can also delay or prevent the development of angina example propranalol.

Calcium-channel blockers

Calcium channel blockers relax blood vessels. They are used to treat high blood pressure, angina, and some arrhythmias example amlodipine.

Cholesterol-lowering drugs

Commonly used cholesterol-lowering medications include statins, bile acid sequestrants, niacin, fibrates, and cholesterol-absorption inhibitors,fluvastatin.

Digitalis (DIGITALIS PURPUREA)

Makes the heart contract harder and is used when the heart can’t pump strongly enough on its own. It also slows down some fast heart rhythms.

Diuretics (water pills)

Decrease fluid buildup in the body and are very effective in treating high blood pressure. In addition, new research suggests that diuretics can help to prevent stroke, heart attack, and heart failure. For those who already have heart failure, diuretics can help to reduce fluid buildup in the lungs and swelling in the feet and ankles examples diuril, frusemide.

 

Nitrates

Relax blood vessels and are used to treat chest pain. Nitrate s in different forms can be used to relieve the pain of an angina attack, to prevent an expected episode, or to reduce the number of attacks that occur by using the medicine regularly on a long-term basis. The most commonly used nitrate for angina is nitroglycerin.

 

STRATEGIES TO PREVENT AND CONTROL HEART DISEASES

If you have a heart disease there are certain things that can be done to improve the health which are;

*. Don’t smoke and avoid second hand or passive smoking

*. Treat blood pressure

*. Eat a healthy diet, low in saturated fat, trans fat and sodium salt (major sources of saturated fat includes Red meat, full – fat dairy products, coconut and palm oils,.

*. Get at least 150minutes of moderate intensity physical activity a week

* .take steps to control your blood sugar if you have diabetes

* Get enough quality sleep

 

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John EH and Arthur CG. Guyton and Hall Textbook of medical physiology 12th edition

Richard A. H, Michelle A.C Richard F. Jose A R and Karen W (2012) lippincott’s illustrated reviews pharmacology 5th edition.

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