SHUBHAM PATNI

Cardiovascular Diseases
Diagnosis and Treatment

9/24/2011

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First of all before we start, we should know the meaning of Cardiovascular Diseases. Cardiovascular Disease is a disease which affects the heart or blood vessels1. Even though, this disease can be prevented and can be healed, around 17.1 to 17.4 million people are dying due to cardiovascular disease. People face cardiovascular disease because of tobacco smoking and other things as well. In this essay we will discuss, some of the reasons why do cardiovascular diseases arise, modern technologies used in diagnosis and treatment of cardiovascular diseases, the effectiveness of the method, moral and ethical issue arising with the use of these technologies and the social or economic issues related to these technologies. Why do cardiovascular diseases arise ? There are many factors on why this diseases happens, one of the reason is because of smoking, not eating a healthy diet, not taking a proper physical activity and many other. In this modern and rapid changing world, we have lots of different ways to diagnose if we are facing cardiovascular disease or not. The doctors will normally tell you do some test which are listed below: Electrocardiograms ( ECGS ) Exercise Stress Test Echocardiograms Angiography

Electrocardiogram is way to diagnose the patients for cardiovascular disease, this works by measuring and recording the electrical activity of the heart. The ESG measures the waves by using the relaxation and contraction of the heart. Each specific wave has a specific letter to it. There are P wave which is when the atria contracts and QRS which is a series of waves when the ventricle contracts. There is also T and U waves which follow after the ventricle contraction. To diagnose and to determine a treatment for cardiovascular disease, there are two important waves which are ST elevations and Q waves. The ST waves can show that if a blockage if the ST waves are depressed or are horizontal. These two waves can suggest that a heart muscle is damaged or that one of the heart artery is blocked. The limitation to this diagnose system is that it is not accurate particularly to women which can turn out that patient does not have a heart problem. This is a risk free system to check if a patient has this problem. Exercise stress Test is a screening tool used to test the effect of the exercise on your heart. This test monitors the heart rhythms, blood pressure and the clinical status. This exercise is supposed to indicate us, how well the heart handles if part of the heart has a decreased blood supply. An ECG or
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http://www.medterms.com/script/main/art.asp?articlekey=18312

echocardiogram is used to measure and visualize the heart activity. The obtain an accurate result, various factors will be taken such as, exercise capacity, Heart rate, changes in the blood pressure and the oxygen level will also be measured. The advantage of this experiment is that, the doctor can accurately figure out the risk especially for men. There are also many main limitations for this method, one of the limitation is the result obtaining of younger people. There will be false results and may also show abnormal readings when there is nothing wrong with the patient. Another limitation is that this method is less accurate for women and that echocardiograms would be suggested. These test are normally safe, but some patients may have chest pain or may also collapse.2 An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure This method is a test that uses ultrasound waves to see the activity of the heart. This method is a better method then the ECG because it can show the images, therefore this a much more accurate way to see if any heart muscle is ruptured and to want extant. There are no limitations in this method as it is accurate to both genders.3 Angiographic is a test mainly for the people who are having acute coronary syndrome. This method is also needed when they need to find out, the exact amount of disease which is present in the coronary artery. A narrow tube is inserted into an artery, normally legs or arms. A special dye is added into the tube and an X-Ray traces the path of the dye. This shows the path of the dye and reviles any blocked parts. Here is a table showing the advantages and limitations of these methods : Advantages Electrocardiogram Exercise Stress Test Echocardiogram Angiographic Limitations

The good news, however, is that 80% of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention.
Eat a healthy diet: A balanced diet is crucial to a healthy heart and circulation system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt, sugar and fat intake intake. Take regular physical activity: At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight.
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http://health.nytimes.com/health/guides/test/exercise-stress-test/overview.html http://health.nytimes.com/health/guides/test/echocardiogram/overview.html

Avoid tobacco use: Tobacco in every form is very harmful to health - cigarettes, cigars, pipes, or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year. Check and control your cardiovascular risk:

Know your blood pressure: High blood pressure usually has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked.

Know your blood sugar: Raised blood glucose (diabetes) increases the risk of heart attacks and strokes. If you have diabetes it is very important to control your blood pressure and blood sugar to minimize the risk.

Know your blood lipids: Raised blood cholesterol and abnormal blood lipids increase the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.

Sometimes medication can't control all the symptoms of heart disease. Surgery may be needed to open or replace the blocked arteries, repair damaged valves or simply keep the patient alive.

Common operations for heart disease include: Coronary angioplasty Coronary angioplasty where a long, thin, hollow tube or catheter is passed through an incision up into the coronary arteries. A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle. Find out more about coronary heart disease.

Atherectomy Atherectomy uses a rotating shaver on the end of a catheter, introduced through a blood vessel in the leg or arm, which is fed through to the blocked coronary artery.

Coronary bypass surgery Coronary bypass surgery, is an operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.

Valve replacement Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue).

Heart valve replacement Heart valve surgery may be required if drugs are unable to control the problem.

Cardiac pacemakers When the electrical system of the heart becomes damaged or faulty, it may be necessary to put in an artificial pacemaker to make the heart beat regularly. This involves on operation to put a wire into the heart, attached to an external device and battery, to deliver electrical signals to the heart.

Rest and recovery Despite huge advances in heart surgery techniques, recovery can be slow and, in a significant number of cases, a variety of complications ranging from infection to stroke cause long-term problems. The length of time it takes to recover after any of the above procedures depends on the type of surgery, the type of anaesthetic administered, and the age and overall state of health of the patient. It's extremely common to be easily upset and tired for the first three to six months after surgery, so it's important to get plenty of rest.

Likewise, it's extremely important to attend a cardiac rehabilitation programme to attain your optimum level of health and to learn how to modify your lifestyle to minimise the chance of future heart problems. For a small number of patients, depression is a persistent problem.Forgetfulness is also common, but normal memory will usually return after about six months. In some cases, people find they have more persistent problems with aspects of intellectual function, including memory. This may be related to the use of the bypass pump used to circulate blood around the body while the heart is being operated on, which can cause tiny clots that block small arteries in the brain.

After any kind of heart surgery it's extremely important to pay attention to your lifestyle, watch your diet and become more active, to promote recovery and to help improve the health of the heart and blood vessels. A GP or cardiac nurse will be able to advise you.

Driving should be avoided for at least a month after bypass surgery. Contact the Driver and Vehicle Licensing Agency(DVLA) for details.

Rehabilitation is crucial for people who have suffered heart attacks and now have poorer health as a result. Attendance at rehabilitation programmes run by a hospital or another centre usually start four to six weeks after a heart attack and last for around six to eight weeks. Programmes can also be followed at home. The aim is to improve fitness and aid recovery at the same time as improving confidence and quality of life. This is done through exercise, relaxation and information on lifestyles, including diet and risk factors, and treatment.

Medications. Many types of medications are used to treat angina and CAD. They include:

Anti-platelet and anticoagulant drugs (used for preventing heart disease and preventing blood clots prior to surgery or after stent insertion) Beta blockers ACE inhibitors Nitrates Calcium channel blockers Surgery. Surgery is usually recommended for people who have: Unstable angina that does not respond promptly to medical treatment Severe recurrent episodes of angina that last more than 20 minutes Acute coronary syndrome Severe coronary artery disease (severe angina, multi-artery involvement, evidence of ischemia, or significant narrowing of left main coronary artery), particularly if abnormalities are evident in the left ventricle of the heart, the main pumping chamber The two main surgical procedures for patients with coronary artery disease are:

Coronary artery bypass grafting (commonly called bypass or CABG), which is usually reserved for patients with severe coronary artery disease. Percutaneous coronary intervention (commonly called angioplasty or PCI), usually with coronary artery stent placement. PCI is less invasive than CABG, but blood vessels can close up again (restenosis) so that patients require additional procedures. The decision to choose angioplasty or coronary artery bypass depends on a patients individual profile, including the number and types of coronary arteries involved, the health stability, previous procedures, patient choice, and more.