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.
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