Coronary Heart DiseaseGroup Sixteen

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NOV. 28TH/2014

Brief Overview

Waxy substance called plaque builds up in the coronary arteries Condition called atherosclerosis

If the flow of oxygen rich blood to your heart is reduced or blocked, angina or heart attack can occur potentially fatal

CHD is caused by genetic and environmental factors Leading cause of death worldwide and most common cause of

death in Ireland In 2008, 10,000 people died from Cardiovascular Disease (CVD)

5,000 were heart attack and 2,500 were from stroke

Brief Overview

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Patient “Bob”

Bob is 43 years of age Long term smoker Lives a relatively unhealthy lifestyle Family history of Diabetes Overweight and has an inactive job

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Medical Role – Signs and Symptoms

Symptoms arise when the heart is experiencing a huge exertion (e.g. during exercise)

Angina pectoris (chest pain) Shortness of breath Other minor CHD symptoms include: Dizziness Sweating Palpitations Nausea

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Diagnosis

The doctor would assess Bob’s medical records and family history

Procedures to diagnose CHD include: Electrocardiogram (EKG) Echocardiography Chest x-rays Stress testing

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Repercussions of CHD

There are far more dangerous and life-threatening outcomes of CHD, which include: Heart attack Arrhythmia (fibrillation) Cardiac arrest Myocardial ischemia Silent ischemia

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Treatment (Surgical Procedures)

CHD cannot be entirely cured Further complications, such as cardiac arrest or death

can be prevented via surgery. Types of Surgery: Angioplasty and Stent Placement Coronary Artery BypassGrafting Heart Transplant

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Pharmacological Role

Pharmacists play an key role in: Prescription Education Why they are taking it and what it does Dispensing Drugs (Controlled amounts) Safety Hazards including sideaffects, inter-medication interactions

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Lipid Modification Drugs

LDL is the main cause of fat build up in the arteries Lipid Modification Drugs Target and remove cholesterol

(Specifically Low Density Lipoprotein) Drugs which fall into this category are called Statins, Fibrates

and Bile Acid Sequestrates Effective with reducingCHD over a long period of

time

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Anti Platelet Drugs

Blood Thinning Drugs Achieve this by targeting platelets

Ex: Aspirin, Heparin and Clopidogrel

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Vasodilators

Improve blood flow by increasing artery size (Vasodilation) Smooth muscle relaxation

Nitric Oxide based drugs Decrease in blood pressure and increase in blood flow Ex: Isosorbide, Mononitrate and Dinitrate

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Beta Blockers & Calcium Channel Blockers

Noradrenaline is a neurotransmitterthat increases heart rate Beta Blockers prevent the binding of noradrenaline onto themyocardial cells

Effective in relieving angina

Muscles need calcium to contract Calcium Channel Blockers block calcium from reaching the muscles of

vessel walls Muscles relax increase in blood flow, and lower blood pressure

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ACE Inhibitors & ARBs

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Angiotensin is the most powerful vasoconstrictor hormone ACE Angiotensin Converting Enzyme ACE Inhibitors prevent this Angiotensin Converting Enzyme from

activating the angiotensin This prevents vasoconstriction leads to increased blood flow

ARB Angiotensin Receptor Blockers Block angiotensin from the receptors on the vessel walls Leads to increased blood flow

Diuretic Drugs

Flush excess salt and water from the body

This leads to a decrease inblood volume and blood

pressure

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Physiotherapist’s Role

Prevention and rehabilitationPrevention is vital cause no problems in the futureRehabilitation equally important as the treatment Important so that the patient will return to original health

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Prevention

Aiding the patient to live a healthier lifestyle in accordance to diet, exercise and general wellbeing.

Diet consuming less saturated dietary fats Keeping cholesterol levels low to prevent

hypercholesterolemia Exercise- Increase exercise per day reduce the

chance of hypertension General Wellbeing- quit smoking

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Cardiac Rehabilitation

Aim to educate the patient about the disease Build a healthy lifestyle Exercise plans to lead the patient to optimum cardiac Consists of four phases: Phase I: Inpatient period Phase II: Early post-discharge period Phase III: Supervisedoutpatient programme,including structured exercise Phase IV: Long-term follow-up/maintenance in primary care

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Phase I : Inpatient Period

Initiated as soon as soon as someone has been admitted to hospital

Integral part of careAssessed through a physical, the physiotherapist

negotiates an informal plan for diet, exercise and wellbeing

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Phase II : Early Post-Discharge Period

Follow a diet that is: Low in saturated and trans fats High in the types of fat found in fish and olive oil High in fiber Low in salt and sugar

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Phase II : Early Post-Discharge Period

Exercise strengthens the heartRecover faster and prevent any future issues

Develop an exercise plan: Moderate intensity exercise relative to the patient Muscle strengthening Warm up and cool down! Ensure the patient is not pushedtoo hard and heart BPM is kept below 75% of the Max BPM

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Phase III – Supervised Outpatient Programme

With structured exercisesOutpatient hospital based programme that consists of: Identification of the risk of the patient Prescription of an exercise programme Re-evaluation of the risk factors, with further health

advice and education

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Phase IV – Long Term Follow Up

Emphasis on maintenance of exercise sessionsMaintenance of long term individual goals of the patientProvision of psychological support for the patientMonitoring of clinical status and follow up of general progress

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Conclusion

Works Cited

1.NHLBI. What Is Coronary Heart Disease? - NHLBI, NIH [Internet]. National Heart, Lung and Blood Institute. 2014 [cited 2014 Nov 18]. Available from: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/#2. Vibhuti N Singh, Alan D Forker, Francisco Talavera, Michael E Zevitz. Heart Disease Causes, Symptoms, Treatment - Coronary Heart Disease Causes and Symptoms - eMedicineHealth [Internet]. eMedicince Health. 2014 [cited 2014 Nov 18]. Available from: http://www.emedicinehealth.com/coronary_heart_disease/page2_em.htm3. Mayo Clinic. Myocardial ischemia Definition - Diseases and Conditions - Mayo Clinic [Internet]. 2014 [cited 2014 Nov 22]. Available from: http://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/basics/definition/CON-200350964. David C. Dugdale, Michael A. Chen, David Zieve. Coronary heart disease: MedlinePlus Medical Encyclopedia [Internet]. MedlinePlus. 2012 [cited 2014 Nov 21]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm5. American Association of Colleges of Pharmacy. Role of a Pharmacist. http://www.aacp.org/resources/student/pharmacyforyou/Pages/roleofapharmacist.aspx (accessed 15/11/2014). 6. National Health services. Coronary Heart Disease - Treatment. http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/treatment.aspx (accessed 20/11/2014).

Works Cited

7. SRS Pharmaceuticals . ISCHEMIC HEART DISEASE : CAUSES, SYMPTOMS, PREVENTION & TREATMENT. http://www.srspharma.com/ischemic-heart-disease-treatment-causes-symptoms.htm (accessed 20/11/2014).8. Healthwise Staff. Beta-Blockers for Coronary Artery Disease. http://www.webmd.com/heart-disease/beta-blockers-for-coronary-artery-disease (accessed 17/11/2014).9. Dr Gurvinder Rull. Calcium-channel Blockers. http://www.patient.co.uk/health/calcium-channel-blockers-leaflet (accessed 16/11/2014).10. MedicineNet. ARBs & ACE inhibitors... Powerful Blood Pressure Treatments. http://www.medicinenet.com/script/main/art.asp?articlekey=18025&page=2 (accessed 15/11/2014).11. Irish Heart Foundation. Cardiac Rehabilitation . http://www.irishheart.ie/iopen24/cardiac-rehabilitation-t-11_1100.html (accessed 20/12/2014).12. National Heart,Lung, and Blood Institute . How To Prevent and Control Coronary Heart Disease Risk Factors. http://www.nhlbi.nih.gov/health/health-topics/topics/hd/prevent (accessed 20/12/2014).13. Irish Heart Foundation. Physical Activity. http://www.irishheart.ie/iopen24/physical-activity-t-7_19_73.html (accessed 20/12/2014).