Alison Lovkay
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3. Be familiar with the different types of cardiopulmonary diseases, including the onset, diagnosis, symptoms, treatment and challenges of each as well as learn different types of cardiac medications.
Angina
Angina pectoris means “chest pain”. It is a condition where the heart is not getting enough blood and the lack of oxygen is causing chest discomfort. Angina is caused because of the blockage in arteries, and it can be stable or unstable. Symptoms may include chest pain radiating to the shoulder, arm, jaw, neck or back, discomfort that feels like tightness, squeezing, crushing, burning, or aching, discomfort that occurs at rest, shortness of breath and sweating. Stable angina is usually when these symptoms occur during activity and unstable angina is when it happens with no exertion. Unstable angina is a warning sign that a heart attack my happen soon and this is why most people end up in the hospital and eventually at cardiac rehab. Antiplatelet drugs are often used to treat and prevent unstable angina.
Coronary Artery Disease
The coronary arteries are the major blood vessels that supply the heart with blood, oxygen and nutrients. Over time, cholesterol deposits, or plaque, build up in these arteries. This narrows the path of blood, decreasing blood flow to the heart. This will then cause angina and shortness of breath. When a coronary artery becomes completely blocked, a heart attack will occur. There are a lot of causes of coronary artery disease, including smoking, hypertension, high cholesterol, diabetes, and having a sedentary lifestyle. When someone experiences symptoms of CAD, there are a lot of tests that can be done to come to a diagnosis. EKG’s, echocardiograms, stress test and catheterization are the most popular. When it is determined that your arteries are not supplying the heart with enough blood, there are lifestyle changes that need to take place, as well as a long list of medications. Patients with CAD are advised not to smoke, to eat healthy, exercise regularly, lose weight and reduce stress. They are also advised to take statins, aspirin, beta-blockers, nitroglycerin and ACE inhibitors. Sometimes stent placement or a CABG is needed.
Myocardial infarction
When atherosclerosis occurs over time as a result of coronary artery disease, a myocardial infarction may occur. The arteries are clogged from the fatty, calcified plaque and it triggers a blood clot that blocks the flow of blow. It was believed for a long time that heart attacks are a direct result of plaque but in the 1980s, studies confirmed that it is the sudden formation of blood clot that causes it. When plaque builds up, it is difficult for blood to travel. When the blood gets backed up, it causes clots. These clots can form along the surface or travel through the artery until it gets stuck. It is when the clot completely blocks off the artery that a heart attack occurs. 1/3 of all heart attacks occur with no prior warning signs. Sometimes it can go without symptoms and people may not even know they are experiencing this event. Most of the time, there are symptoms. These includes chest pain or pressure lasting longer than 10 minutes, pain radiating down the left arm and often into the jaw line, shortness of breath, profuse sweating, dizziness, muscle weakness, nausea, a feeling of impending doom and a choking sensation. Risk factors for myocardial infarctions include smoking, high cholesterol diets, hypertension, sedentary lifestyle, obesity, age and a family history. When a patient has a heart attack, they are admitted to the hospital immediately. The doctor will take a patient history and perform a physical exam. An EKG will be performed to identify any abnormal heart rhythms, and blood tests will be ordered to measure the release of certain proteins from the damaged heart muscle. A coronary angiography will be performed to view the possible narrowing of the coronary arteries. It is advised to take aspirin if you know you are experiencing the event as it can help break apart the clot that is causing the blockage. Oxygen, antihypertensive drugs, nitroglycerin and dopamine may also be administered. Treatment may include an angioplasty, coronary bypass surgery, electronic implants or even a heart transplant. An angioplasty is a procedure that will open up narrowed arteries by inflating a balloon inside the artery. Coronary bypass surgery will create different routes for the blood flow so that the heart is no longer starved of oxygen. Electronic implants, such as a pacemaker may be attached so that the heart maintains strong and regular. If the heart goes too long without oxygen it may be so badly damaged that it may require a heart transplant. After a myocardial infarction occurs, lifestyle choices must be altered. Exercise is a great way to strengthen the heart muscle and to reduce the risk of another heart attack.
Congestive Heart Failure
CHF does not mean the heart is not working, it simply means that it is pumping weaker than normal. Blood is moving through the heart and body at a slower rate and pressure increases. This means that the heart cannot pump enough oxygen and nutrients to meet the body’s needs. In result of this, the chambers of the heart stretch to hold more blood and the walls become stiff and thick. This helps the blood move but the walls become weakened and are then unable to pump efficiently. When the blood is moving slowly, it becomes backed up, hence why it is called “congestive” heart failure. With a decreased volume of blood reaching the kidneys, a hormonal cascade occurs that results in the retention of sodium and water. These efforts help the short-term lack of nutrients but in the long run, have many negative effects. In left sided failure, increased pressure in the pulmonary veins forces fluid into the surrounding alveoli causing them to no longer function properly. This decreases oxygen transport throughout the body. In right-sided failure, increased pressure in the veins returning from the body and the retention of sodium and water leads to fluid accumulation and swelling. Most of time, both sides are failing. Symptoms include shortness of breath and wheezing after physical exertion (left-sided), severe fatigue and weakness, dry cough, cough that produces blood sputum (left-sided), frequent urination (right-sided), swelling of the ankles and feet (right-sided), rapid weight gain (right-sided), abdominal pain (right-sided), swollen neck veins (right-sided), loss of appetite, irregular or rapid heart beat and anxiety. Smoking, alcohol, unhealthy diets, sedentary lifestyles and other cardiac diseases are the most common causes of CHF. Treatment includes lifestyle changes, vasodilators, diuretics, anticoagulants, beta-blockers, and ace inhibitors. Lifestyle changes should include reducing sat intake, eating smaller and more frequent meals and avoiding caffeine. Vasodilators are the foundation of treatment in CHF and are prescribed to dilate blood vessels, reducing blood pressure and easing blood flow. Diuretics reduce amount of fluid in the body are useful for patients with edema.
COPD
Chronic Obstructive Pulmonary Disease is a term that is used to describe diseases including emphysema, bronchitis, and asthma. These diseases all have one thing in common; there is increasing breathlessness. There are many causes and reasons why people develop COPD, but in any case, there is blocked airflow and breathing is difficult. Emphysema occurs when the alveoli at the end of the bronchioles are gradually destroyed. Bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from your lungs. The main symptom of bronchitis is a cough that lasts for at least three months. Other symptoms include shortness of breath, wheezing, chest tightness, having to clear your throat first thing in the morning, a clear sputum produced by coughing, cyanosis, respiratory infections, lack of energy and weight loss. Often, patients experience exacerbations, which is when the symptoms get much worse for a few days. The main cause of COPD is smoking. Other causes include exposure to fumes, pipe smoke, air pollution, workplace exposure to dust, smoke or fumes, etc. In working airways, air travels down the trachea into the lungs through two large bronchi. The airways divide into smaller tubes called bronchioles and end in clusters of tiny air sacs, called alveoli. These air sacs are surrounded by capillaries, which is the site of respiration. The oxygen you inhale passes into the capillaries and into the blood stream at the same time that carbon dioxide is exhaled. COPD causes the bronchial tubes and alveoli to lose elasticity and partially collapse. This limits the oxygen going into the bloodstream as well as trapping in carbon dioxide. Often, COPD leads to respiratory infections such as the flu and pneumonia, high blood pressure, heart problems, lung cancer and depression. The most essential step in treatment for COPD is to stop smoking. It is the only way to keep the COPD from getting worse. Medications such as bronchodilators, inhaled steroids and inhalers are often used. The bronchodilators are used to relax the muscles around the airways. This can relieve coughing and shortness of breath. Inhaled steroids reduce airway inflammation and help prevent exacerbations. Inhalers combine the bronchodilators and inhaled steroids. Oxygen therapy is needed if there is not enough oxygen in the blood and is used for patients that have low oxygen saturations. It is important to learn good breathing techniques. Making sure that you are relaxed and taking deep breaths can really help relieve the shortness of breath. We practice pursed lip breathing at Miriam, where the patients purse their lips together, breathe in through the nose and out through the mouth, allowing the exhale to be a few seconds longer than the inhale. Exercising is also important because it improves overall strength and the strength of the respiratory muscles.
Pulmonary Hypertension
Pulmonary hypertension is a rare lung disorder where the pulmonary arteries that carry blood from the heart to the lung become narrowed. This makes it difficult for blood to flow through the vessels, increasing the blood pressure. This high pressure strains the right ventricle, causing it to expand in size. It begins to overwork and gradually becomes weaker until it loses the ability to pump enough blood to the lungs. There are many causes why the pulmonary arteries become narrowed, but it is believed that the most common reason is injury to the layer of cells that line the capillaries of the lungs. This changes the way the cells interact with the smooth muscle, and as a result contracts more than normal and becomes narrowed. Symptoms include shortness of breath, fatigue, and dizziness, swelling in the ankles, abdomen or legs, cyanosis and chest pain. In advanced stages, irregular heart beat, racing pulse, and passing out are common symptoms as well. Liver diseases, rheumatic diseases, lung diseases, heart failure, low oxygen conditions and genetic predisposition often cause pulmonary hypertension. Oxygen is often used to replace the low oxygen in the blood. Blood thinners are used so that the blood is moving more freely, diuretics are used to remove extra fluid from the tissues and vasodilators are used to lower the pulmonary blood pressure. The only cure for pulmonary hypertension is a lung transplant. It is only used when symptoms do not get better with medications and lifestyle changes.
