Management of Cardiovascular Disease

Management of Cardiovascular Disease

Prevention is the best cure, and this is put into practice both before and after a heart attack: lifestyle changes, including a focus on diet, nutrition and smoking are a step in the treatment of all cardiovascular diseases.

Depending on the severity and outcome of the disease, various other treatments can be put into place:

Drugs used to treat CHD include[i]:
· Aspirin – Aspirin helps to lower the risk of a heart attack for those who have already had one. It also helps to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure such as coronary angioplasty.
· Digitalis – makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms.
· ACE (angiotensin converting enzyme) inhibitor – stops the production of a chemical that makes blood vessels narrow and is used to help control high blood pressure and for damaged heart muscle. It may be prescribed after a heart attack to help the heart pump blood better. It is also used for persons with heart failure, a condition in which the heart is unable to pump enough blood to supply the body's needs.
· Beta blocker – slows the heart and makes it beat with less contracting force, so blood pressure drops and the heart works less hard. It is used for high blood pressure, chest pain, and to prevent a repeat heart attack.
· Nitrates (including nitroglycerine) – relaxes blood vessels and stops chest pain.
· Calcium channel blocker – relaxes blood vessels and is used for high blood pressure and chest pain.
· Diuretic – decreases fluid in the body and is used for high blood pressure. Diuretics are sometimes referred to as "water pills."
· Blood cholesterol-lowering agents – decrease LDL cholesterol levels in the blood.
· Thrombolytic agents–also called "clot busting drugs," they are given during a heart attack to break up a blood clot in a coronary artery in order to restore blood flow.
‘statin’ medication
angioplasty, to reopen/repair damaged blood vessels
bypass surgery
nitro-glycerine can prevent myocardial infarction from progressing[ii]

Cardiac Rehabilitation has 4 main areas[iii]:
§ Medical evaluation. A thorough evaluation helps your health care team assess your physical abilities, medical limitations and other conditions you may have. Your team explores what risk factors you may have for such cardiovascular diseases as stroke or high blood pressure. All of these findings help your team tailor a cardiac rehabilitation program to your individual situation, making sure it's safe and effective.
§ Physical activity. No longer is bed rest recommended if you have serious heart problems — it just won't improve your fitness. Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing or even jogging and other endurance activities. You may also do strength training to increase your muscular fitness. Don't worry if you've never exercised before. Your cardiac rehabilitation team will make sure the program moves at a pace you're comfortable with.
§ Lifestyle education. Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol. You receive tips on breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue that may accompany your heart condition. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as medications and sexual activity.
§ Psychosocial support. Adjusting to a serious health problem often takes time. You may experience depression or anxiety, lose touch with your social support system, or have to stop working for several weeks. Counseling or vocational or occupational therapy shows you healthy ways to cope.


[i] http://www.nhlbi.nih.gov/actintime/hdm/hdm.htm
[ii] http://en.wikipedia.org/wiki/Cardiovascular_disease/
[iii] http://www.nlm.nih.gov/medlineplus/heartdiseases.html

Syndicate Session – May 11, 2006

Scenario One
a) What is the likely diagnosis?
Scurvy.
b) What measures were taken to prevent these problems?
Dietary measures: increase in fruit and vegetable intake, and hence intake in vitamin C. Citrus fruits in particular had a long life and good effect.
c) How did Captain Cook avoid this problem on his ships?
Captain Cook used ‘portable soup’, vinegar and malt, along with Sauerkraut. This was believed to combat the problem of gaining vitamins without fresh fruit.
d) What is the chemical basis for this problem?
Normal collagen synthesis depends upon the hydroxylation of proline and lysine. These are non-standard amino-acids and are found abundantly in collagen and hence confer strength to collagen fibrils. The enzymes which catalyse these reactions require vitamin, and therefore, without ascorbic acid, hydroxyproline and hydroxylysine are not formed, and the collagen fibrils are considerably weaker than normal.

Scenario 2
a) What are the underlying principles which must be considered in the management of a compound fracture?
The most important principle is the aiding of the inflammatory response, by the removal of infection and foreign matter.
b) The fracture does not heal, and a chronic inflammation occurs. Pus is constantly discharged, and after seven months it has not healed. What is the likely diagnosis?
Due to the nature of the wound, and the underlying tissue being exposed to the environment, due to penetration of the skin, a foreign body is likely to be causing chronic infection.

Congratulations to the Dux

Congratulations to the other Tim,

for duxing the 5%er.

Sadly, all he receives is a PGO on his report card.

Mummy will be happy.

With love,

Tim

Group R Ethics Legal Debrief

Hey All.

I will post under comments what Jackie emailed me, as promised.

If anyone wants the word file, just drop me a line.

For non group R people, our theme 4 tutor wanted to give us these... could be fun.

much love,
Tim