2015-07-30 11:21:31

Published on 2015-07-30 11:21:31




The study of the heart, the vessels involved and the medical conditions that may affect its function is defined by the term cardiology. Additionally cardiology includes the study of the heart’s normal functions, the symptoms of diseases, the tests carried out and the treatments. This sector has developed greatly over the past 50 years with new diagnosis and treatments available to help prevent fatal conditions and prolong life.


It is vital to understand the various aspects compromising cardiology as it is now becoming the most common disease in developing countries. This in turn means that this sector has the largest amount of tools for diagnosis and treatment. However this results in high costs which cause an economic burden on society especially for the young and middle aged patients who are in their productive years.


Risk Factors

Nurse with ederlyA variety of conditions have been identified to link with the incidence of coronary heart disease (CHD). There are two types of risk factors; the ones that can be treated, controlled or modified and the others that cannot be controlled. If an individual has more than one risk factor the incidence of developing CHD increases.


The uncontrollable risk factors are age, heredity/race and gender. Individuals are most likely to pass away from CHD over the age of 65, thus meaning that there is a lower risk at younger ages. Additionally males are more at risk than women, even when the risk increases in women after menopause. Furthermore heredity and race may affect the occurrence of CHD because there are higher rates of obesity and diabetes in those areas, for example in Mexican Americans, Native Americans and Native Hawaiians.


The controllable factors are high cholesterol, high blood pressure, smoking, diabetes, inactivity and obesity. Each of these will be analysed in depth below.


High Cholesterol


collapse veinsCholesterol is a type of fat that is essential for the body as it is needed for the structure of the cell membrane and its function and for other cells. Cholesterol can be found in the cell walls, but if there is an excess this can result in arthrosclerosis in the cardiovascular system, which then lead to cardiovascular disease (CVD). There are two types of cholesterol, high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), the latter being more damaging to the body. A high presence of LDL is toxic to blood vessels and can result in plaque formation in the arteries, where there is a build-up and leads to heart attacks and strokes.


High cholesterol does not demonstrate any symptoms, however a certain amount of the population demonstrates xanthomas which are depositions of cholesterol that can be typically noted around the eyes, on the tendons of fingers, elbows and knees. A diagnosis can be made with a blood test which identifies the levels and the different types of cholesterols, where the blood is drawn from the patient who has been in a fasting state so a reliable baseline is established.


There are a variety of treatments that can be provided for high cholesterol. The medication typically used now-a-days is statin. This is a drug that prevents cholesterol production of the liver by blocking the enzyme HMG-CoA reductase. A guide has been published for an effective utilization of statin, this involves administrating statin when the LDL cholesterol upper limit is 130mg/dL. However if the patient has displayed only one or no risk factors and has no history of CVD the level’s upper limit should be over 160 mg/dL. Evidence has been published regarding the effectiveness of statins in reducing death rates, prolonging life. Stroke incidents are reduced by 19-27% in individuals taking statin drugs as a treatment. Evidence however does not suggest that if healthy individuals take satin they will reduce the risk of coronary disease. There are however side effects of utilizing statin, such as its toxicity to the liver damaging it and creating muscle damage.  An alternative drug that can be utilized is niacin, also known as nicotinic acid or vitamin B3. However this drug can cause side effects such as flushing, palpitations, and rash in some people. These symptoms can be reduced by an aspirin. Another common drug used to treat high levels of cholesterol is cholestyramine. However the side effects can cause severe unpleasantness through constipation. Liver transplant is used as a treatment in the cases where liver cells cannot metabolize LDL cholesterol properly. Patients that may need liver transplant are those that may have a genetic defect and where levels of LDL cholesterol are high.


High Blood Pressure

Blood pressure

Hypertension, also known as high blood pressure, is when systolic pressure is higher than 140mmHG and a diastolic pressure is above 90mmHg. The results of hypertension strain the heart by making it pump harder which causes ventricular muscles to become stiff, larger and thicker. The symptoms are not physically visible and those individuals are unaware of suffering from this condition. Hypertension is present more common in older people and additionally it is more often seen in men than women. Certain cases of hypertension may develop due to endocrine or hormonal disorders but in such cases the treatment involves removing the causational factor. A general treatment which will reduce the blood pressure is medication as the risk will decrease for heart diseases and strokes. Additionally decreasing the salt in a patient’s diet will allow the body to avoid retaining water which would increase the blood volume, thus avoiding creating a greater strain on the heart.




Men smokingSmoking is not only a potential cause of lung cancer but increases the risk of CHD and peripheral vascular disease (PVD). Smoking increases the heart rate and blood pressure as it contains stimulants in the tobacco. Additionally other chemicals, not only nicotine, can be toxic to the blood vessels, constricting them, leading to injury of their lining and thus accelerating atherosclerosis. Furthermore these chemicals can affect levels of fibrinogen, increasing the risk of clots in the blood, thus leading to a heart attack. Tobacco smoke contains carbon monoxide which reduces the supply of oxygen in the blood, meaning that the heart pumps harder to provide the body with the amount of oxygen it needs to function. Nicotine specifically stimulates the production of adrenaline, leading to the heart beating faster, thus raising the blood pressure and the heart is strained as it needs to work harder.  Statistics have shown that stopping smoking will extend life of an average of six years and will reduce dramatically the occurrence of CVD. It is important to note that smokers are four times more likely than non-smokers to develop CVD. There are numerous methods which a patient can follow to stop smoking, including rigorous programs, hypnosis, or medication.



Diabetes causes metabolic derangements which are highly complex, leading to changes in nerves and blood vessels that get damaged over the years. Therefore the strain on the heart increases, especially if blood sugar is not well controlled. The risk isincreased with diabetes of developing not only CVD but also kidney disease and stroke, leading to premature death.


Inactivity and Obesity

 food and rule

A lifestyle that is not active will increase the risk of developing coronary heart disease. The reason for this is because activity helps reduce body fat which increases blood pressure and stresses the heart to work harder. It has been noted that regular or moderately vigorous physical activity can help prevent blood vessel diseases and heart diseases.


Contributory Risk Factors


There are some risk factors that contribute to coronary heart disease. These however are difficult factors to measure and evaluate. Additionally not every individual will manifest these factors. These risk factors include psychological stress, anger, high body mass index, physical inactivity and alcohol. All of which can be controlled.


Psychological stress depends on the individual, making it a subjective factor. There are no tools which are precise enough to accurately measure the stress level and the correlated biochemicals vary between individuals. Extreme stress leads to hypertension, metabolic derangements, an increase in adrenaline levels changes the cardiac function with electrical alterations resulting in arrhythmias. Studies have been carried out displaying that treating psychological distress is possible with psychological support, counselling and home visits.


The body mass index is utilized to measure the composition of the body, predicting the amount of body fat in an individual based on weight in relation to height. If the body composition of the patient is overweight it is advised to lower their weight so that in turn the blood pressure in hypertension, lowers glucose in the blood, and lowers LDL all factors that contribute to coronary heart disease.


Alcohol has a complex relationship with the heart as the effects caused depend on the amount of alcohol that is consumed. Moderate alcohol can protect the heart by reducing the formation of plaque and raising HDL cholesterol. Additionally alcohol prevents clumping and clotting in the blood as it has an 

glass with alcoholanticoagulant effect. The risk in alcohol appears when an individual drinks more than three drinks a day as the effects are then toxic on the heart. One drink is considered to be 1.5 fluid ounces (fl oz) of 80-proof spirits, 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. Drinking can result in high blood pressure, damaging the heart muscle leading to alcoholic cardiomyopathy. This results in the heart not pumping properly, causing an enlargement to the heart and then a congestive failure. Additionally drinking will introduce more fat into the body by raising the levels of triglyceride in the circulation. Furthermore alcohol will cause irregular heartbeats causing atrial fibrillation.





Prevention Strategies

-  Smoking

Tips are available online, provided by other quitters. For a more personal care, doctors, practice nurse or a pharmacist can provide you with quitting advice and further information. Additionally there is an NHS Smoking Helpline with the phones provided below.


England 0800 434 6677


Wales 0800 085 2219


Scotland 0800 84 84 84


Northern Ireland 0808 812 8008


A practical tip is as follows: set a date to give up, plan what can help you quit, utilize different methods, get support as talking about quitting is beneficial, change your daily routine to avoid smoking breaks and buying cigarettes, and finally treat yourself with your saved money.


-  Alcohol


It is suggested to keep within the guidelines not drinking more than 3-4 units of alcohol for men and 2-3 units for women, where the units are based on the drink size and its alcohol strength. A recommendation is to have some days off from drinking, aiming to have minimum two non alcoholic days. If however large amounts of alcohol are taken in by the body in one sitting, the individual should avoid drinking for the following 48 hours, allowing the body to recover. A warning for patients taking sleeping tablets or painkillers is given as alcohol will then have a stronger effect on the body.


-   Stress


The first practical step to undertake is to change in a positive way the lifestyle of an individual. This can be carried out with a balanced diet and regular physical activity. Additionally knowing how to relax is an important factor in stress relief. Previous patients have mentioned that physical activity, yoga and relaxation techniques are effective in decreasing stress. Scheduling one technique a day can help individuals relax. Furthermore identifying situations where stress peaks allows individuals to actively avoid them. Talking to a GP can be useful as they can advise the best way to deal with stress and anxiousness.


-   Managing weight


There are two methods that can be used to manage weight: a balanced diet and staying active. Crash diets are not seen as beneficial as it doesn’t provide the body with the nutrients it needs. The following are food groups which should compromise a regular diet; plenty of fruits and vegetables, plenty of starchy foods, some dairy products, some non-dairy sources of protein such as meat and fish, and just a small amount of drinks or foods high in fats and sugar. It has been advised to try to choose food that are lower in fat, salt and sugar whenever possible. A balanced diet needs to include the typical 5 per day of fruit and vegetables which can be frozen, dried, tinned or fresh. One portion is considered to be 8-g or 30z. There are a variety of fats to choose from and one should be able to identify the right ones. Small amounts of polyunsaturated and mono fats should replace saturated fats, trans fats should be cut down, and lastly only small quantities of unsaturated fats should be consumed such as oils. It must be noted that a large amount of saturated fat will increase cholesterol in the blood risking the development of coronary heart disease.


Staying active can be a simple process to undergo. The first tip is to keep a record of the activity you do. The individual can start small, set realistic goals, make exercise part of the daily routine, keep moving , involve friends and family, try a variety of activities to find the most enjoyable ones, set visible reminders, and most importantly reward yourself with treats that are not food related such as a new magazine.


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