House Call: Cardio Vascular Diseases
Cardio Vascular Diseases (CVD) are the number one cause of death globally and more people die annually from CVDs than any other cause. Joining us tonight is Cheryl Farley, RN, BSN, Cardiac Rehab and Pulmonary Rehab at UHC, to discuss. World Heart Day, which is on September 29.
1). Help familiarize us with the types of cardiovascular diseases?
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include:
· coronary heart disease – disease of the blood vessels supplying the heart muscle;
· cerebrovascular disease – disease of the blood vessels supplying the brain;
· peripheral arterial disease – disease of blood vessels supplying the arms and legs;
· rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
· congenital heart disease – malformations of heart structure existing at birth;
· deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.
2). What are the risk factors for cardiovascular disease?
The cause of heart attacks and strokes are usually the presence of a combination of risk factors, such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol, hypertension, diabetes and hyperlipidemia.
The effects of behavioral risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of developing a heart attack, stroke, heart failure and other complications.
Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. In addition, drug treatment of diabetes, hypertension and high blood lipids may be necessary to reduce cardiovascular risk and prevent heart attacks and strokes. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behavior.
There are also a number of underlying determinants of CVDs or “the causes of the causes”. These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.
3). What are common symptoms of cardiovascular diseases?
Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease. Symptoms of a heart attack include:
· pain or discomfort in the center of the chest;
· pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.
In addition, the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale. Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of:
· numbness of the face, arm, or leg, especially on one side of the body;
· confusion, difficulty speaking or understanding speech;
· difficulty seeing with one or both eyes;
· difficulty walking, dizziness, loss of balance or coordination;
· severe headache with no known cause; and
· fainting or unconsciousness.
People experiencing these symptoms should seek medical care immediately.
4). How can the burden of cardiovascular diseases be reduced?
At the individual level, for prevention of first heart attacks and strokes, individual health-care interventions need to be targeted to those at high total cardiovascular risk or those with single risk factor levels above traditional thresholds, such as hypertension and hypercholesterolemia. The former approach is more cost-effective than the latter and has the potential to substantially reduce cardiovascular events. This approach is feasible in primary care in low-resource settings, including by non-physician health workers.
For secondary prevention of cardiovascular disease in those with established disease, including diabetes, treatment with the following medications are necessary:
· angiotensin-converting enzyme inhibitors
The benefits of these interventions are largely independent, but when used together with smoking cessation, nearly 75% of recurrent vascular events may be prevented. Currently there are major gaps in the implementation of these interventions particularly at the primary health care level.
In addition costly surgical operations are sometimes required to treat CVDs. They include:
· coronary artery bypass
· balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage)
· valve repair and replacement
· heart transplantation
· artificial heart operations
Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.
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