There are also some causes of heart disease which are self induced such as smoking, lack of exercise and poor diet which can lead to obesity. Smoking can have a deadly effect on the heart. Nicotine and other poisonous chemicals in a smoker’s bloodstream damage the lining of arteries including coronary arteries. Carbon monoxide, which is a poisonous gas, cuts down the amount of oxygen the blood can carry. So when you smoke, your heart has to work harder to get less oxygen (source 1, 2 & 5). Smoking also lowers vitamin levels such as Vitamin C, which arteries thrive on. Smoking causes narrowing of the arteries with acceleration of atherosclerosis, easier formation of blood clots and a lower ratio of HDL: LDL. Furthermore nicotine increases blood pressure (which is already a major risk factor) by causing the body to release adrenaline that increases the heartbeat and constricts the arteries (source 1 &2).
Studies around the world showed that high consumption of vegetables and fruit could cut the risk of heart disease by between 20 and 30%. The reports also highlight the fact that European countries with high fruit and vegetable consumption have low rates of heart disease (source 11). Perhaps a more healthy diet of fruit and vegetables is not what is lowering heart disease but their replacement and therefore avoidance of fatty foods high in cholesterol. A lack of exercise means that the body loses out on its benefits that include causing tachycardia that increases the force and frequency of contractions, which increases oxygen consumption and strengthens the heart (source 1 & 2). In sever cases a lack of exercise and a poor diet can lead to obesity, which leads to changes in the concentration of triglyceride and cholesterol in the blood. This leads to a large amount of atheromas deposits in the arteries and a high risk of heart disease (source 12).
This leads to a number of ethical questions on the topic of ‘self induced’ heart disease. Should medical professionals have to care for and the public have to pay for the treatment received by those who have helped to create their own heath problems. Millions each year are spent by the government on facilities and workers to take care of heart disease patients. This comes in the form of pay for medical professionals, diagnostic equipment, drugs, surgery and beds. Many patients have increased their own risk of heart disease either through smoking, incorrect diet or lack of exercise although this is not true to all. Many patients are asked to cut down and if possible quit smoking before treatment as it is proven that this increases the chance of survival by 16%(in by-pass surgery (source 10). Those who are obese are asked to lose weight so that they also have a higher chance of survival. In some cases doctors have refused to treat heavy smokers who refuse to quit unless treatment is urgently needed. In 1993 David Blunkett’s response to such a case was, “Everyone has a right to the NHS, no matter how foolish they have been in their own behaviour,” (source 10) It is also fair to comment that smokers do pay a great deal of tax which goes to the governments funds to pay for such care; however those with a poor health due to life style do not.
Treatment can be given to patients when the correct diagnosis has made by a number of tests. A 24-hour ECG (electrocardiogram) is used to detect abnormal activity such as arrhythmias during the course of a normal day. An exercise ECG is one in which the heart is monitored while the patient is exercising or is put under stress. This is done by attaching sensors to various parts of the body and chest that are connected to an ECG machine. The Machine senses the electrical activity, which stimulates the heart, and so a heartbeat can be recorded. This allows medical staff to test how the heart copes in different situations and if there are any arrhythmias (source 1 & 13). This is in no way internal or intrusive to the patient.
If a patient is believed to have had a myocardial infraction then tests for certain enzymes can be done. Damage to cells of a particular organ may cause release of enzymes into the blood. Therefore measurements of enzyme levels in plasma are useful is diagnosing a wide variety of diseases including myocardial infraction. Certain enzymes show significant changes in their plasma levels following myocardial infarction (source 13). In this case patients only need blood samples taken.
Ecocardiography is the term used to describe ultrasound scans of the heart. It can be used to study a variety of cardiac disorders. It works by sound waves of a high frequency being directed into the body. Different tissues reflect sound differently and the reflections can be used to form images (source3).
Nuclear imaging is an excellent diagnostic tool because it shows not only the structure of an organ or body part, but the function of the organ as well. A gamma cameras is used to detect the movement of the very low-level radioactive chemicals that are introduced into the body. The chemicals emit faint gamma ray signals, which are measured by a gamma camera, which convert signal into a digital picture, still or moving. It can be used to monitor blood flow through the heart and its walls (source14).
Injecting a radio opaque die into a patient and then taking an X-ray can detect narrowing of the arteries. This is called arteriography (source 1 &13).
MRI (magnetic resonance imaging) scanning can generate thin-section images of the heart without surgical invasion and in a relatively short period of time. It provides a great deal of structural information. It uses the body’s biological magnets to produce accurate images (Source 1 &3).
Treatments are chosen on their suitableness for the patient and the specific problem that the patient has which has been diagnosed by the tests mentioned or perhaps an alternate method. There are a multitude of treatments available; these include surgical treatments and drug treatments. In many cases the heart must be stopped while it is being operated on, to allow this a heart lung machine is used. While the heart is stopped the machine pumps and oxygenates the blood whilst preventing clotting.
A Coronary angioplasty is a procedure used to treat angina. It involves squashing atheromas in blocked arteries. It is usually performed with a balloon on a catheter that is passed into an artery and directed to the blockage under X-ray. The balloon is inflated, then deflated and removed. Often a stent is left in place to keep the artery open and prevent a reblockage. Recovery from the procedure usually takes 5 to 7 days (source 6).
A coronary bypass is where an artery from another part of the body is taken and grafted between the aorta and up to four coronary arteries. This bypasses blockages and replenishes supplies of blood and oxygen. Recovery from the procedure usually takes 2 to 3 months (source 6). Both of these procedures can be performed as microsurgery leaving as little scarring as possible.
Heart transplants are offered to people who suffer cardiomyopathy, have blocked blood vessels or heart muscle damage, have no other major health problems, have tried other treatments which have failed, are under 60 years of age (usually) and are willing to stick to life style changes. In this procedure the patient’s heart is removed and replaced with that of a suitable donor. After the transplant the patient will receive drugs to prevent rejection of the new heart; this has made transplants more successful in recent years. The downside to this procedure is that there are very few suitable donors so this procedure is usually only available to those with advanced heart disease. Also the patient will have to take immunisation drugs for the rest of their life to prevent rejection along with other drugs to prevent infection along with a possible complete change of life style in all three procedures (source 6 & 16).
Every year in the UK 7000 patient have pacemakers implanted. The implantation takes one to two hours of surgery. The pacemaker is usually smaller than a matchbox and is placed commonly near to the collarbone with in any wires being fed through a vein straight to the tissue in the heart. During the procedure the patient is usually awake and under local anaesthetic. For safety the implant is insulated. Recovery usually takes 2 days, unfortunately the battery will run out in approximately 10 years and so it will have to be replaced (source 1 & 15). There are two different types of pace maker available the first is fixed rate insensitive, this means that it delivers a constant unchanging impulses and doesn’t adapt to the changing need of the heart and body. The other type is a demand sensitive pacemaker, it senses impulses from the sino-arterial node, which suppress it however it also senses when the heart misses a beat, which causes it to send impulses to the heart. This type of pace maker works on a requirement only bases. These may be used when patients whose sino-arterial node sends out signals too slowly, or the electrical pathway is partly or completely blocked, or the timing of atrial and ventricular contractions is uncoordinated (asynchronous), in this case a double chamber pace maker is used.
There are many drugs on the market today some of which are prescribed after surgical procedure and others in the case of preventing an advancement of heart disease. Beta-blockers are used to prevent angina and lower high blood pressure. They block stress hormones, which induce tachycardia. They may be used to lower the risk of subsequent heart attacks and help patients with arrhythmias and over time they improve the hearts pumping ability. They cannot be proscribed to people with asthma, emphysema, hypotension or bradycardia (slow pulse) (source 6 &7); this limits their market.
Angiotensin converting enzyme-inhibitors (ace) are used to treat patients who have suffered heart failure and high blood pressure. They block hormones (angiotensin) that narrow the blood vessels, thus decreasing the amount of work the heart has to do. When taking this drug patients should avoid potassium as ACE inhibitors retain potassium and can cause life-threatening complications (source 6 & 7).
Anti-arrhythmia drugs are used to control the rhythm of the heartbeat. Their success depends upon having the exact amount necessary in the blood stream. This means it can take some time to get the dosage correct and experts will need to monitor patient health for a long time; however this may be a prefer this method over a pacemaker (source 6 & 7).
Anti-platelet drugs are given to treat coronary artery disease; heart attack, angina and they are also prescribed after angioplasty and bypass surgery. They prevent the formation of blood clots, thus stopping platelets from clots during atherosclerosis and causing further health risks. This drug should not be taken by anyone who has bleeding problems or is going to have surgery as they may cause excessive bleeding (source 6 & 7).
Aspirin is a common drug that decreases pain, inhibits blood clots. People who benefit from it are may suffer atherosclerosis, angina, bypass surgery and others with a high risk of myocardial infraction. The risks of taking aspirin are the possible development of stomach ulcers and abdominal bleeding. Many people must avoid aspirin such as pregnant women, people awaiting surgery, heavy drinkers, people with ulcers or any bleeding problem and people who are already on pain medication (source 6 & 7).
Calcium channel blockers are given to patients with high blood pressure, coronary heart disease, abnormal heart rhythms and hypertrophic cardiomyopathy. They work by preventing the movement of calcium in cells thus relaxing blood vessels and increase blood supply to the heart while reducing its workload (source 6 & 7).
Thrombolytics are clot-busting drugs that are injected to prevent the ongoing damage of heart attacks, which saves many lives in emergencies. They may cause low blood pressure and excess bleeding in some patients after administration. As with all drugs these have a variety of side effects although most are temporary (source 6 & 7).
The advances in modern technology and medicine help to save thousands of lives and give better quality of life all over the globe. However the attitudes of many modern societies encourage a poor, unhealthy life style. The numbers needing treatment could be lowered a great deal by people looking after their own health and so preventing the need for any sort of treatment. Simple yet effective life style changes such as not smoking, lowering LDL cholesterol by eating a low calorie diet, taking care of blood pressure problems with medical advice and treatment and exercise regularly to strengthen the heart and reduce high blood pressure (source 1 & 2). Treatment is highly beneficial but prevention is even more so.
