The Heart Essay Research Paper CONTENTS3

Multiple Risk Factors

The five major risk factors described above do more than just

add to one another. There is a virtual multiplication effect in

victims with more than one risk factor. (Chart: Risk Factors)

DIAGNOSIS

It is very important for patients to tell their doctors of the

symptoms as honestly and accurately as possible. The doctor will

need to know about other symptoms that may distinguish angina from

other conditions, such as esophagitis, pleurisy, costochondritis,

pericarditis, a broken rib, a pinched nerve, a ruptured aorta, a

lung tumour, gallstones, ulcers, pancreatitis, a collapsed lung or

just be nervous. Each of the above mentioned is capable of causing

chest pain.

A patient may take a physical examination, which includes

taking the pulse and blood pressure, listening to the heart and

lung with a stethoscope, and checking weight. Usually an

experienced cardiologist can distinguish it as a cardiac or

noncardiac situation within minutes.

There are also routine tests, such as urine and blood tests,

which can be used to determine body fat level. Blood test can also

tests for:

Anemia – where the level of haemogoblin is too low, and can

restrict the supply of blood to the heart.

Kidney function – levels of various salts, and waste products,

mainly urea and creatinine in the blood. Normally these levels

should be quite low.

There are other factors which can be tested such as salt

level, blood fat and sugar levels.

A chest x-ray provides the doctor with information about the

size of the heart. Like any other muscles in the body, if the heart

works too hard for a period of time, it develops, or enlarges.

An electrocardiogram (ECG) is the tracing of the electrical

activity of the heart. As the heart beats and relaxes, the signals

of the heart’s electrical activities are picked up and the pattern

is recorded. The pattern consists of a series of alternating

plateaus and sharp peaks. ECG can indicate if high blood pressure

has produced any strain on the heart. It can tell if the heart is

beating regularly or irregularly, fast or slow. It can also pick up

unnoticed heart attacks. A variation of the ECG is the

veterocardiogram (VCG). It performs exactly like the ECG except the

electrical activity is shown in the form of loops, or vectors,

which can be watched on a screen, printed on paper, or

photographed. What makes VCG superior to ECG is that VCG provides

a three-dimensional view of a single heart beat.

DRUG TREATMENT

Angina patients are usually prescribed at least one drug. Some

of the drugs prescribed improve blood flow, while others reduce the

strain on the heart. Commonly prescribed drugs are nitrates, beta-

blockers, and Calcium antagonists. It should be noted that drugs

for angina only relief the pain, it does nothing to correct the

underlying disorder.

Nitrates

Nitroglycerine, which is the basis of dynamite, relaxes the

smooth fibres of the blood vessels, allowing the arteries to

dilate. They have a tendency to produce flushing and headaches

because the arteries in the head and other parts of the body will

also dilate.

Glyceryl trinitrate is a short-acting drug in the form of

small tablets. It is taken under the tongue for maximum and rapid

absorption since that area is lined with capillaries. It usually

relieves the pain within a minute or two. One of the drawbacks of

trinitrates is that they can be exposed too long as they

deteriorate in sunlight. Trinitrates also come in the form of

ointment or “transdermal” sticky patch which can be applied to the

skin.

Dinitrates and mononitrates are used for the prevention of

angina attacks rather than as pain relievers. They are slower

acting than trinitrates, but they have a more prolonged effect.

They have to be taken regularly, usually three to four times a day.

Dinitrates are more common than trinitrates or tetranitrates.

Beta-blockers

Beta-blockers are used to prevent angina attacks. They reduce

the work of the heart by regulating the heart beat, as well as

blood pressure; the amount of oxygen required is thereby reduced.

These drugs can block the effects of the stress hormones adrenaline

and noradrenaline at sites called beta receptors in the heart and

blood vessels. These hormones increase both blood pressure and

heart rate. Other sites affected by these hormones are known as

alpha receptors.

There are side effects, however, for using beta-blockers.

Further reduction in the pumping action may drive to a heart

failure if the heart is strained by heart disease. Hands and feet

get cold due to the constriction of peripheral vessels. Beta-

blockers can sometimes pass into the brain fluids, and causes vivid

dreams, sleep disturbance, and depression. There is also a

possibility of developing skin rashes and dry eyes. Some beta-

blockers raise the level of blood cholesterol and triglycerides.

Calcium antagonists

These drugs help prevent angina by moping up calcium in the

artery walls. The arteries then become relaxed and dilated, so

reducing the resistance to blood flow, and the heart receives more

blood and oxygen. They also help the heart muscle to use the oxygen

and nutrients in the blood more efficiently. In larger dose they

also help lower the blood pressure. The drawback for calcium

antagonists is that they tend to cause dizziness and fluid

retention, resulting in swollen ankles.

Other Medications

There are new drugs being developed constantly. Pexid, for

example, is useful if other drugs fail in severe angina attacks.

However, it produces more side effects than others, such as pins

and needles and numbness in limbs, muscle weakness, and liver

damage. It may also precipitate diabetes, and damages to the

retina.

SURGERY

When medications or any other means of treatment are unable to

control the pain of angina attacks, surgery is considered. There

are two types of surgical operation available: Coronary Bypass and

Angioplasty. The bypass surgery is the more common, while

angioplasty is relatively new and is also a minor operation.

Surgery is only a “last resort” to provide relief and should not be

viewed as a permanent cure for the underlying disease, which can

only be controlled by changing one’s lifestyle.

Coronary Bypass Surgery

The bypass surgery involves extracting a vein from another

part of the body, usually the leg, and uses it to construct a

detour around the diseased coronary artery. This procedure restores

the blood flow to the heart muscle.

Although this may sound risky, the death rate is actually

below 3 per cent. This risk is higher, however, if the disease is

widespread and if the heart muscle is already weakened. If the

grafted artery becomes blocked, a heart attack may occur after the

operation.

The number of bypasses depends on the number of coronary

arteries affected. Coronary artery disease may affect one, two, or

all three arteries. If more than one artery is affected, then

several grafts will have to be carried out during the operation.

About 20 per cent of the patients considered for surgery have only

one diseased vessel. In 50 per cent of the patients, there are two

affected arteries, and in 30 per cent the disease strikes all three

arteries. These patients are known to be suffering from triple

vessel disease and require a triple-bypass. Triple vessel disease

and disease of the left main coronary artery before it divides into

two branches are the most serious conditions.

The operation itself incorporates making an incision down the

length of the breastbone in order to expose the heart. The patient

is connected to a heart-lung machine, which takes over the function

of the heart and lungs during the operation and also keeps the

patient alive. At the same time, a small incision is made on the

leg to remove a section of the vein.

Once the section of vein has been removed, it is attached to

the heart. One end of the vein is sewn to the aorta, while the

other end is sewn into the affected coronary artery just beyond the

diseased segment. The grafted vein now becomes the new artery

through which the blood can flow freely beyond the obstruction. The

original artery is thus bypassed. The whole operation requires

about four to five hours, and may be longer if there is more than

one bypass involved. After the operation, the patient is sent to

the Intensive Care Unit (ICU) for recovery.

The angina pain is usually relieved or controlled, partially

or completely, by the operation. However, the operation does not

cure the underlying disease, so the effects may begin to diminish

after a while, which may be anywhere from a few months to several

years. The only way patients can avoid this from happening is to

change their lifestyles.

Angioplasty

This operation is a relatively new procedure, and it is known

in full as transluminal balloon coronary angioplasty. It entails

“squashing” the atherosclerotic plaque with balloons. A very thin

balloon catheter is inserted into the artery in the arm or the leg

of a patient under general anaesthetic. The balloon catheter is

guided under x-ray just beyond the narrowed coronary artery. Once

there, the balloon is inflated with fluid and the fatty deposits

are squashed against the artery walls. The balloon is then deflated

and drawn out of the body.

This technique is a much simpler and more economical

alternative to the bypass surgery. The procedure itself requires

less time and the patient only remains in the hospital for a few

days afterward. Exactly how long the operation takes depends on

where and in how many places the artery is narrowed. It is most

suitable when the disease is limited to the left anterior

descending artery, but sometimes the plaques are simply too hard,

making them impossible to be squashed, in which case a bypass might

be necessary.

SELF-HELP

The only way patients can prevent the condition of their heart

from deteriorating any further is to change their lifestyles.

Although drugs and surgery exist, if the heart is exposed to

pressure continuously and it strains any further, there will come

one day when nothing works, and all that remain is a one-way ticket

to heaven.

The following are some advices on how people can change the

way they live, and enjoy a lifetime with a healthy heart once more.

Work

A person should limit the amount of exertions to the point

where angina might occur. This varies from person to person, some

people can do just as much work as they did before developing

angina, but only at a slower pace. Try to delegate more, reassess

your priorities, and learn to pace yourself. If the rate of work is

uncontrollable, think about changing the job.

Exercise

Everyone should exercise regularly to one’s limits. This may

sound contradictory that, on the one hand, you are told to limit

your exertion and, on the other, you are told to exercise. It is

actually better if one exercise regularly within his or her limits.

Exercises can be grouped into two categories: isotonic and

isometric. People suffering from angina should limit themselves to

only isotonic exercises. This means one group of muscle is relaxed

while another group is contracted. Examples of this type of

exercise include walking, swimming leisurely, and yoga; some harder

exercises are cycling and jogging.

Weight Loss

The more weight there is on the body, the more work the heart

has to do. Reducing unnecessary weight will reduce the amount of

strain on the heart, and likely lower blood pressure as well. One

can lose weight by simply eating less than their normal intake, but

keep in mind that the major goal is to cut down on fatty and sugar

foods, which are low in nutrients and high in calories.

Diet

What you eat can have a direct effect on the kind of condition

you are in. To stay fit and healthy, eat fewer animal fats, and

foods that are high in cholesterol. They include fatty meat, lard,

suet, butter, cream and hard cheese, eggs, prawns, offal and so on.

Also, the amount of salt intake should be reduced. Eat more food

containing a high amount of fibre, such as wholegrain cereal

products, pulses, wholemeal bread, as well as fresh fruits and

vegetables.

Alcohol, tea and coffee

Alcohol in moderation does no harm to the body, but it does

contain calories and may slow the weight loss progress. People can

drink as much mineral water, fruit juice and ordinary or herb tea

as they wish, but no more than two cups of coffee per day.

Cigarettes

It has been medically proven that cigarettes do the body no

good at all. It makes the heart beat faster, constricts the blood

vessels, and generally increases the amount of work the heart has

to do. The only right thing to do is to quit smoking, it will not

be easy, but it is worth the effort.

Stress

Stress can actually be classified as a major risk factor, and

it is one neglected by most people. Try to avoid those heated

arguments and emotional situations that increase blood pressure, as

well as stimulate the release of stress hormones. If they are

unavoidable, try to anticipate them and prevent the attack by

sucking an angina tablet beforehand.

Relaxation

Help your body to relax when feeling tense by sitting or lying

down quietly. Close your eyes, breathe slowly and deeply through

the nose, make each exhalation long, soft and steady. An adequate

amount of sleep each night is always important.

Sexual activity

It is true that sexual intercourse may bring on an angina

attack, but the chronic frustration of abstinence may cause more

tension. If intercourse precipitates angina, either suck on an

angina tablet a few minutes beforehand or let your partner assume

the more active role.

TYPE-A BEHAVIOUR PATTERN

There is a marked increase of coronary heart disease in most

industrialized societies in the twentieth century. This may have

resulted, in part, because these societies reward those who

performed more quickly, aggressively, and competitively.

Type-A individuals of both sexes were considered to have the

following characteristics:

(1) an intense, sustained drive to achieve self-

selected but often poorly defined goals.

(2) a profound inclination and eagerness to compete.

(3) a persistent desire for recognition and

advancement.

(4) a continuous involvement in multiple and diverse

functions subject to time restrictions.

(5) habitual propensity to accelerate the rate of

execution of most physical and mental functions.

(6) extraordinary mental and physical alertness.

(7) aggressive and hostile feelings.

The enhanced competitiveness of type-A persons leads to an

aggressive and ambitious achievement orientation, increased mental

and physical alertness, muscular tension, and an explosive and

rapid style of speech. A sense of time urgency leads to

restlessness, impatience, and acceleration of most activities. This

in turn may result in irritability and the enhanced potential for

type-A hostility and anger. Type-A individuals are thus at an

increased risk of developing coronary heart disease.

The type-A behaviour pattern is defined as an action-emotion

complex involving10:

(1) behavioural dispositions (e.g., ambitiousness,

aggressiveness, competitiveness, and impatience).

(2) specific behaviours (e.g., muscle tenseness,

alertness, rapid and emphatic speech stylistics,

and accelerated pace of most activities).

(3) emotional responses (e.g., irritation, hostility,

and anger).

Comparatively, type-A persons are more risky to develop

coronary heart disease than type-B individuals, whose manners and

behaviours are relaxed. The risk, however, is independent of the

risk factors. Not all physicians are convinced that type-A

behaviour pattern is a risk factor, and thousands of studies and

researches are currently being done by experts on this topic.

THE CARDIAC REHAB PROGRAM

This program at the Credit Valley Hospital is designed to help

patients with coronary artery disease lower their overall risk, and

to prevent any further attacks. It provides rehabilitation for

patients who are likely to have heart attacks, have had heart

attacks, or had a recent surgery.

Most patients come to this one-hour class two nights a week,

which takes place outside the physiotherapy department. The class

is ran by volunteers, and is usually supervised by a kinesiologist.

The patients come in a little before 6:00 pm, and have their blood

pressure taken. At six o’clock, volunteers will take the patients

through a fifteen-minute warm-up. After the warm-up, the patients

will go on with their exercise for half an hour. The patients can

choose from walking, rowing machines, stationary bicycles, and arm

ergometer, or a combination of two or more as their exercise.

Each patient is reassessed once a month, in order to keep

track of their progress. Volunteers will ask the patient being

reassessed a series of questions, which includes frequency of

exercise, type of exercise program, problems with exercise, etc.

About 6:30, when the patients are near the peak of their

exercise, the ones being reassessed will have to have their pulse

and blood pressure measured; to see if they have reached their

“target heart rate”, and to see if their blood pressure goes up

as expected.

At about 6:45, the patients end their exercise and cool-down

begins. Cool-down is in a way similar to warm-up, only this helps

the patients to relax their hearts, as well as their body after a

half-hour workout. After cool-down most patients have their blood

pressure taken again just to make sure nothing unusual occurs.

CONCLUSION

Angina pectoris is not a disease which affect a person’s

heart permanently, but to encounter angina pain means something

is wrong. The pain is the heart’s distress signal, a built-in

warning device indicating that the heart has reached its maximum

workload. Upon experiencing angina, precautions should be taken.

A person’s lifestyle plays a major role in determining the

chance of developing heart diseases. If people do not learn how

to prevent it themselves, coronary artery disease will remain as

the single biggest killer in the world, by far.