Thursday, May 14, 2009

TREATMENT & MEDICATION OF CARDIOVASCULAR DISEASES

  • Medications
    • Alpha-adrenergic antagonists
      • Known as alpha blockers
      • Work by keeping the hormone (noradrenaline) away; (activates the sympathetic nervous system that in turn accelerates heart rate, constrict blood vessels and increase BP
      • Treatment for high blood pressure (hypertension)
      • Alpha blockers, block that effect causes the vessels to be dilated, remain open and relax
    • Angiotensin converting enzyme (ACE) inhibitors
      • Angiotensins are peptides that act as vasoconstricting agents (causing blood vessels to narrow)
      • Narrowing of the diameter of the blood vessels increases the blood pressure
      • ACE converts angiotensin to its activated form (angiotensin II hormone) enabling it to function
      • The ACE inhibitors are drugs that inhibit the formation of angiotensin II
      • When angiotensin II is blocked, the arteries remain wider and allow blood to flow through with less pressure on the vessels, thereby lowering blood pressure
    • Angiotensin II receptor blockers (ARBs)
      • Angiotensin II is a very potent chemical that narrows the blood vessels
      • The narrowing causes high blood pressure
      • ARB's block the action of Angiotensin II
      • Blood vessels dilate and blood pressure is reduced
    • Anticoagulants
    • Aspirin
      • Blood clots are formed by platelets grouping together
      • Aspirin makes platelets less sticky, minimize blood clot formation & prevent further blockage of artery
      • Increase blood flow to the heart and brain
      • Reduces
        • Stroke in those who have had a previous stroke
        • Heart attack in those who have had a previous heart attack or experience angina
        • Death or complications from a heart attack if the drug is taken at the first signs of a heart attack
    • Bile acid sequestrants
      • Bind bile acids in the intestine and cause more of the bile acids to be excreted in the stool
      • Reduces the amount of bile acids returning to the liver and forces the ilver to produce more bile acids to replace the bile acids lost in the stool
    • Calcium channel blockers
      • Reduces the amount of calcium that goes into these muscle cells
      • This causes the muscle to relax
    • Diuretics
      • Help your body get rid of unneeded water and salt through the urine
      • Make it easier for your heart to pump and control blood pressure
    • Ezetimibe
      • Works by preventing cholesterol from being absorbed from the small intestine into the blood stream
    • Niacin ( Nicotinic Acid)
      • Inhibit the liver from creating VLDL
    • Statins (HMG-CoA reductase inhibitors)
      • Works by blocking a key enzyme in the production of cholesterol
    • Thrombolytics
      • Works by dissolving a major clot quickly
      • Restart blood flow to the heart
      • Help prevent damage to the heart muscle


 

  • Surgeries and procedures
    • Angioplasty (PTCA)
      • Tiny wire with a balloon at the end is put into a large artery in the groin or arm
      • Then it is passed up to the heart and into the blocked section of a coronary artery using special x-ray guidance
      • Balloon is blown up inside the blocked part of the artery to open it wide again
    • Stent
      • Stent is implanted during PTCA procedure
      • Stent is a flexible wire mesh tube that holds the newly expanded artery open
      • Some stents are coated with one of several medications, which decreases the likelihood of restenosis
      • Restenosis is the narrowing of the vessel as it heals and remodels after a PTCA procedure
    • Atherectomy
      • A procedure to remove plaque from the arteries
      • Done by clearing a clogged artery by cutting, shaving or vaporizing the plaque
      • The device used is attached to a thin tube called a catheter
      • Balloon angioplasty or stenting maybe used after an atherectomy
    • Brachytherapy
      • Placing a source of radioactivity close to or implanted within the tissue to be treated
      • Is done after a repeat angioplasty and after inserting a new stent
      • Uses a catheter to place a ribbon of radioactive seeds into the diseased artery for three to 20 minutes and then removed it
      • Radiation prevents excessive scar tissue from forming
    • Cardiac Rehabilitation
      • A medically supervised program that helps improve the health and well-being of people who have heart disease
      • Include
        • exercise training
        • education on heart healthy living
        • counseling to reduce stress and help you return to an active life
      • helps people who have heart problems:
        • recover after myocardial infarction and heart surgery
        • prevent future hospital stay, heart problems and death related to heart problems
        • Address risk factors that lead to coronary artery disease and other heart problems.
        • Adopt healthy lifestyle changes
        • Improve their health and quality of life
      • http://www.nhlbi.nih.gov/health/dci/Diseases/rehab/rehab_whatis.html
    • Carotid Artery Surgery
      • A procedure to restore blood flow to the brain by using
        • Endarterectomy
          • The surgeon will make an incision on your neck over your carotid artery. The surgeon will put a catheter in place. Blood will flow through the catheter around the blocked area during surgery.
          • Then your surgeon will open your carotid artery. The surgeon will then remove the plaque inside your artery.
          • Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
        • Carotid angioplasty and stenting
      • http://www.nlm.nih.gov/medlineplus/ency/article/002951.htm
    • Coronary Artery Bypass Surgery
    • External Counterpulsation (ECP)
      • Noninvasive technique to increase oxygen-rich blood flow to heart and to reduce heart's workload
      • Pressure cuffs on the legs are inflated in sequences.
      • During diastole, the 3 cuffs rapidly inflate in succession from the calf to the upper thigh.  This propels blood back to the heart.  The cuffs quickly deflate just before the next heartbeat. 
      • As a result, the blood vessels in the legs are gently compressed and the blood is forced back to the heart.
      • This technique
        • Lowers the pressure the heart must pump against
        • Increases the rate of return of blood to the heart
        • Increases blood pressure while the heart is resting
      • http://www.americanheart.org/presenter.jhtml?identifier=4577
      • http://www.hearthealthywomen.org/index.php?view=article&id=147&Itemid=1&option=com_content
    • Heart Transplant
      • Removes a damaged of diseased heart and replaces it with a healthy one
      • May be recommended to
    • Heart Valve Replacement Surgery
    • Transmyocardial Revascularization
      • A procedure used to relieve severe angina or chest pain in very ill patients who are not candidates for bypass surgery or angioplasty
      • A surgeon makes an incision on the left breast to expose the heart
      • Using a laser, the surgeon drills a series of holes from the outside of the heart into the heart's pumping chamber
      • The laser may stimulate new blood vessels to grow
      • It may destroy nerve fibers to the heart, making patients unable to feel their chest pain
      • http://www.americanheart.org/presenter.jhtml?identifier=4782
    • Valvuloplasty (Balloon or Surgical)
      • A procedure in which a narrowed heart valve is stretched open using a procedure that does not require open heart surgery
      • A procedure in which a thin tube (catheter) that has a small defalted balloon at the tip is inserted through the skin in the groin area into a blood vessel
      • Threaded up to the opening of the narrowed heart valve
      • The balloon is inflated, which stretches the valve open
      • http://medical-dictionary.thefreedictionary.com/Balloon+Valvuloplasty
  • Lifestyle changes
    • Eat a healthy diet
      • Heart-healthy diet
        • Nutritious and well-balanced
        • Low in saturated fat, trans fat, cholesterol and salt
        • High in fruits, vegetables, and whole grains
    • Maintain a healthy weight
      • Excess body fat leads to health problems such as type 2 diabetes, hypertension, hypercholesterolemia
      • People who are obese are more likely to develop heart disease, stroke, hypertension, diabetes, gallbladder disease, joint pain, sleep apnea and osteoarthritis
      • Eat less and move more
    • Exercise regularly (at least 30 minutes)
      • Improves heart function
      • Lowers blood pressure and blood cholesterol
      • Help manage diabetes
      • Helps control weight
    • Quit or do not start smoking
      • Tobacco smoke increases your risk of atherosclerosis
      • Smokers have more than twice the risk of having a heart attack as non-smokers
      • Smoking is the biggest risk factor for sudden cardiac death
      • Smokers who have a heart attack are more likely to die than non-smokers who have a heart attack
      • Risk of coronary heart disease drops sharply in the first year that you stop smoking
    • Minimize stress
      • Stress speed up the heart rate
      • People with heart disease are more likely to have a heart attack during times of stress
      • People sometimes respond to stress with unhealthy habits such as smoking or eating salty or high-fat foods

References:


 
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