HEART DISEASE

 

INTRODUCTION

 

          Survival, growth reproduction and productivity of the human organism depend upon a balance between movements of nutrients to the cell and of wastes away from the cell in health this is accomplished by the effective functioning, of 3 factors a pump (the heart) a circulatory circuit and a fluid medium (blood).  Diseases or structural alteration sin any of these three affect the survival of the organism and thus causes many of the cardiac diseases.

Definition:

          Cardiovascular diseases comprise of group of diseases of the heart and vascular system.  The major conditions are ischaemic heart disease, hypertension congenital heart disease and rheumatic heart disease.

 

CORONARY HEART DISEASE

Definition:

          Coronary heart disease has been defined as “impairment of heart function due to inadequate blood flow to the heart compared to its needs” caused by obstructive changes in the coronary circulation to the heart it is the  cause of 25-30 per cent of death in most industrialized countries.

Risk factors

1. Smoking:

          Smoking has been identified as a major CHB risk factors with several possible mechanisms carbon monoxide induced atherogenesis.

2. Hypertension

          Blood pressure is the single most useful test for identifying individuals at high risk of developing CHD.

3. Serum cholesterol

          Elevation of serum cholesterol was one of the factor which carried an increased risk for the development of coronary heart disease.

4. Other risk factors

§        Diabetes

§        Genetic factors

§        Hormones

§        Type of personality

§        Alcohol

§        Oral contraceptives

§        Miscellaneous

Clinical Features

§        Temporary anoxia of myocardium

§        Obstruction of coronary arteries

§        Angina pectoris

§        Myocardial infraction

 

PREVENTION OF CORONARY HEART DISEASE

          WHO expert committee on the prevention of CHD which recommended the following strategies.

a)     Population strategy

a.     Prevention in the whole population

b.    Primordial prevention in whole populations

b)    High risk strategy

c)     Secondary prevention

 

a) Population Strategy

CHD is primarily a mass disease.  The strategy should therefore be based on mass approach focusing mainly on the control of underlying causes in whole populations not merely in individuals.

Specific intervention

The population strategy centers round the following key areas

1) Dietary changes

          The following dietary changes to be appropriate for high incidence populations.

§        Reduction of fact intake to 20-30 percent of total energy intake.

§        A reduction of dietary cholesterol to below 100mg per 1000 kcal per day.

§        An increase in complex carbohydrate consumption.

§        Avoidance of alcohol consumption reduction of salt intake 5g daily or less.

Smoking

          As far as CHD is concerned present evidence does not support promotion of the so-called safer cigarette.

Blood Pressure:

          It has been estimated that even a small reduction in the average blood pressure of the whole population by a mere 2 or 3mm Hg would produce a large reduction in the incidence of cardio vascular complications.

Primordial Prevention

          It involves preventing the emergence and spread of CHD risk factors and life styles that have not yet appeared or become endemic.

          Since the etiology of CHD is multifactorial the approach to prevention should be multifactorial aimed at controlling or modifying as many risk factors as possible.

 

b) High Risk Strategy

i) Identifying risk

          High risk intervention can only start once those at high risk have been identified by means of simple test such as blood pressure and serum cholesterol measurement.

 

 

ii) Specific advice

          Having identified those at high risk the next step will be to bring them under preventive care and motivate them to take positive action against all the identified risk factors.

c) Secondary prevention

          Secondary prevention must be seen as continuation of primary prevention the aim of the secondary prevention is to prevent the recurrence and progression of CHD.

          The principles of secondary prevention are the same as those already set out in the above section eg: Cessation of smoking, control of hyper tension and diabetes healthy nutrition etc.

HYPERTENSION

          Hypertension is a chronic condition of concern due to its role in the causation of coronary heart disease, stroke and other vascular complications.

          It defined as systolic equal or greater than 160mm Hg or diastolic pressure 95 mm Hg.

Risk factors for hypertension

          This may be classified as

1.     Non modifiable risk factors

2.     Modifiable risk factors

1) Non modifiable risk factors

Age

§        Sex

§        Genetic factors

§        Ethnicity

Modifiable risk factors

§        Obesity

§        Salt Intake

§        Saturated fat

§        Alcohol

§        Physical activity

§        Environmental stress

§        Socio economic status

§        Other factors

 

PREVENTION OF HYPERTENSION

        The WHO has recommended the following approaches in the prevention of hypertension

1)    Primary prevention

a.     Population strategy

b.    High risk strategy

2)    Secondary Prevention

 

1) Primary prevention

          Primary prevention has been defined as “all measures” to reduce the incidence of disease in a population by reducing the risk onset”.  The earlier the prevention  starts the more likely it is to be effective.

a) Population strategy

          The population approach is directed at the whole population, irrespective of individual risk levels.

          The goals of population approach is to shift the community distribution of blood pressure towards lower level or biological normality.  This involves a multifactorial approach based on the following intervention.

a)     Nutrition

b)    Weight reduction

c)     Exercise promotion

d)    Health education

 

b) High risk strategy

          This is also part of primary prevention the aim of this approach is to prevent the attainment of levels of blood pressure at which the institution of treatment would be considered.

 

2) Secondary prevention

          The goal of secondary hypertension is to detect and control high blood pressure in affected individuals.  Antihypertensive drug therapy can effectively reduce high blood pressure.

Early case detection:

          The early detection is a major problem.  The only effective methodS of diagnosis of hypertension is to screen the population and treatment.

RHEUMATIC HEART DISEASE

          Rheumatic fever is a febrile disease affecting connective tissues particularly in the heart and joints initiated by infection of the throat by group A beta hemolytic streptococci.

Clinical features

§        Fever

§        Polyarthritis

§        Carditis

§        Nodules

§        Skin rashes

Diagnosis

        The 2002-2003 WHO criteria for the diagnosis of RF and RHD are based on revised Jones criteria and facilitate the diagnosis of

1.     Primary episode of rheumatic fever

2.     Recurrent attack of RF in patients without RHD.

3.     Rheumatic chorea

4.     Rheumatic carditis

5.     Chronic RHD

 

Prevention

a) Primary Prevention

          The aim of primary prevention is to prevent first attack of RF.  By identifying all patients with streptococcal throat infection and treating them with penicillin

b) Secondary prevention

§        Secondary prevention i.e., the prevention of recurrences of rheumatic fever.

§        It consists in identifying those who have had RF and giving them one intramuscular injection of Benzedrine benzyl penicillin at interval of 3 weeks.

§        Patient with carditis the treatment should continued for 10 years.

 

Non medical measures

§        To improving living condition and breaking the poverty disease poverty.

§        Improvement in socio – economic condition particularly better housing.

Congestive Heart Failure

          Heart failure is a state in which the cardiac output is inadequate to meet the peripheral needs of the body.  Clinical features are oedema and dysponea.

Prevention

§        The prevention of heart failure and pulmonary oedema will depend on the detection and adequate treatment of hypertension.

§        In severe cases physical activity should be restricted.

§        During acute stages the diet should be soft and liquid.

Treatment

§        Provide rest to the patient.

§        Checking of the weight of the patient daily.

§        Administration of sedation if needed

§        Provide oxygen inhalation

§        Provide skin care / self care provide pressure care, massage the bony prominence.  In circular movement nurse should have a careful watch on elbows and sacrum.  Lubricant should be applied to the skin since irritation often occurs.

§        Nutrition during acute stage soft and liquid die to be given resuscitation of sodium intake and supplemented with vitamins.

 

Follow UP

§        Educated the family and patient about the nature of disease process and treatment.

§        Tech the patient to observe signs and symptoms of recurrence and to inform doctor immediately.

§        Explain the patient the importance of medication in controlling the disease.

§        Advice the patient not to change the brand of digitalis which he is taking.

§        Teach the patient to take and record his pulse rate.

§        Advice to take diet low in sodium advice not to   expose to extreme heat and cold it increases heart activity.

§        Advice him to avoid excessive eating and drinking.

§        Advice him to stop smoking and taking alcohol.

§        Advice to attend the clinics regularly

§        Advice to take oral potassium dilated with juice and taken after a meal.

1. Congenital heart disease:

        The heart disease follow an abnormality of structure caused by error in fetal development

        The congenital heart disease are two types.

1.      Cyanotic heart diseases

Tetralogy of fallot, transportation of great vessels and tricuspid atresia.

2.      Acyanotic heart diseases

Stenosis, patent ductus arterious, intra-atrial septal defect, pulmonary stenosis

 

Tetratology of fallot: it consists of 4 defects

1.      Ventricular septal defect

2.      Pulmonary stenosis

3.      Right Ventricular hypertrophy

4.      Overriding of aorta

 

This combination produce cyanosis in infant who is often referred to as a blue baby.

Transposition of great vessels

        The aorta arises from the right ventricle instead of the left and blood is pumped back into circulation without having received oxygen from the lungs.

Tricuspid atresia:

        In case complete congenital atresia of the tricuspid valve is present, there is no ductal communication between the right atrium and right ventricle.

Intra – atrial septal defect:

        The foramen ovale or normal opening in the atrial septum fails to close shortly after birth as it should and blood returning from the lungs to the left atrium shunts over to the right atrium.

Pulmonary stenosis:

        It is a narrowing of pulmonary valve, which decreases the amount of blood flowing into the lungs.

PREVENTION

1.        Immunisation against acute infectious diseases such as diphtheria, scarlet fever and measles and control of infection through selective antibiotics to decrease the incidence of infectious complications.

2.        Immune serum globulin for women with the first trimester of pregnancy who have been exposed to measles in an effort to prevent congenital heart diseases or other malformation of their babies.

3.        Children are the major source of rubella infection in the community the best method for preventing rubella in pregnant women is to vaccinate children, this reduce the incidence of measles among pregnancy women and thus reduce congenital anomalies.

 

 

 

CONCLUSION

 

          More people are affected directly or indirectly by cardiac diseases than by any other single disease deaths caused by cardiac disease vary with age.  Congenital and malformation of the heart and closely related vascular system are the caused of over 90 percent of the death.

 

 

 

 

 

 

BIBLIOGRAPHY

 

1.         K.Parks Essentials of Community health Nursing, Forth Edition, page.No.344.

2.         B.T.Basavanthappa Community Health Nursing Second Edition, Jaypee Brothers, medical Publishers (P) Ltd., Pg.No.808-810.