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Pharmacology Of Cardiac Disease

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Question:

Pathophysiology and Pharmacology of Cardiac Disease ?

 

Answer:

Introducation:

Ischaemic Heart Disease-A Cardio-Vascular disease and its risk factors:    

Cardio-vascular diseases have drawn the attention of medical experts for last few years. Ischaemic Heart Disease is one of the most common and fatal heart problems globally. The Australian government invested $4518 million in the year 2008-09 for the treatment of this disease (Cardiovascular diseases top Australian health care spending (AIHW), 2017).  Sometimes it becomes more critical to handle the cardio-vascular diseases as it is related or combined with other diseases. As for example, Amanda is suffering from high blood pressure and constriction of blood vessels. On the other hand, James has atherosclerosis. Thus, both the patient has an increased chance for Ischaemic Heart Disease. Here the detailed pathophysiology’s of their current condition and relating Ischaemic Heart Disease risk factors, pharmacological treatments that will be useful for Amanda and James have been discussed with some relevant points.

According to Mann, Zipes, Libby & Bonow (2014), the cardio-vascular disease may be referred as the condition in which vessels and arteries get affected, blood clots and sometimes some internal structural problem occur. The heart needs adequate blood circulation to supply oxygen. The heart muscles can pump blood to the whole body through the coronary arteries.

Regarding physiology, the condition of Amanda may be defined as the high blood pressure caused by vascular constriction, where blood flow in heart decreases. Vascular constriction in heart will increase the blood pressure, but on the other hand decreases the flow of blood as blood turns away to other lesser resistant areas (Okuyama H, 2017). Amanda is a patient of high blood pressure, and it indicates the greater possibility to be affected by Ischaemic heart disease.

"Athero" means plaque, whereas "sclerosis" means hardening.  Atherosclerosis is the condition where plaque accumulates inside the arteries of the heart. Thus, Oxygen-rich blood gets restriction to reach in rest of the body parts and also inside the heart itself. Slowly the plaques become harden, and the arteries become narrower, which restrict the blood circulation through it. Thus, the blood-circulation of the heart of James is not proper. When the plaque inside the arteries ruptures, it causes luminal thrombosis which is responsible for acute coronary symptom and may lead to sudden death. As opined by Finegold, Asaria & Francis (2013), Atherosclerosis can cause several serious problems including stroke, heart attack, and Ischemic Heart Disease. James is suffering from this problem and has a greater risk of Ischaemic heart disease. 

A brief overview and pathophysiology of Ischaemic Heart Disease:

Ischaemic heart disease is a disease where the supply of blood becomes reduced due to the abnormal condition of heart arteries such as narrower heart arteries. As opined by Del Brutto et al., (2014), it may lead to several serious problems such as heart attacks, myocardial infarction, unstable angina and stable angina. This disease is also known as coronary-artery disease.

                                                    Figure 1: Healthy Coronary artery and Narrower Coronary artery condition

                                                                                             Source: (Foundation, 2017)

Fatty acids accumulate on the inner sides or inner walls of the arteries which supply oxygen-rich blood. This accumulation can occur over several years. When the plaque becomes hardened, the elasticity of the arteries get reduced (Department of Health | Cardiovascular disease, 2017). The narrow and hardened arteries restrict the flow of oxygenated blood to the heart. This cause myocardial cell starvation of oxygen thus heart cannot function properly. Improper vasoconstriction of arteries cause decrease in blood flow through it and leads to “ischemia”.  Reduced release of the endothelial vasodilators also causes improper functionality of coronary arteries especially during stress. Dysfunctions of endothelial portion in atherosclerotic coronary arteries lead to improper vascular constriction and deprivation of regular antithrombotic defenses. This causes overwhelming of endogenous antithrombotic mechanisms. Previously atherosclerotic or narrowed coronary arteries which become severely congested by emerging thrombus, can leads to stable angina and Ischaemic heart disease. Another condition related with Ischaemic heart disease is Inflammation of coronary arteries due to vasculitic syndrome.

In the case of Amanda, as it can be firmly said that hypertension or high blood pressure is one of the significant risk factors for Ischaemic heart disease, so the blood pressure needs to be maintained under 140/90 mmHg for primary prevention of Ischaemic heart disease (Del Brutto et al., 2014).

As James is suffering from atherosclerosis, thus, the arteries of the heart of this patient are already narrower than normal patient due to plaque accumulation. Thus, it can be firmly said that James is easily prone to Ischaemic heart disease.

 

Pharmacology treatment of Ischaemic Heart Disease:

In order to treat Ischaemic heart disease, several types of medicines or therapies is used which is described as follows:

(1) Organic nitrates such as isosorbidedinitrate, isosorbidemononitrate which are used to treat this disease as it relaxes the muscles of the heart and improve blood circulation.

(2) The current study reveals the fact that Beta blockers such as propranolol, timolol, atenolol and much more and calcium channel blockers such as nifedipine, amlodipine and much more are used alone or combining with ACE inhibitors, as it reduces oxygen consumption and cardiac work. The physiological effects of norepinephrine and epinephrine (catecholamines) regulated by some specific beta-adrenergic and alpha adrenergic receptors (Foundation, 2017). Beta blockers inhibit catecholamines from binding with those receptors.

 (3) Statins are also used to treat this heart problem as this is helpful to reduce cholesterol level of blood. It acts as HMG-CoA reductase inhibitor. Statins cause 60% reduction in a number of cardiac attacks (Coronary heart disease and atherosclerosis, 2017). Ischemic heart disease also occurs due to the increased cholesterol levels. Statins are used to reduce the Cholesterol levels in hypercholesterolemia. Statins are the HMG-CoA Reductase inhibitors.

(4) As opined by Mann, Zipes, Libby & Bonow (2014), Aspirin is used as an anti-platelet drug which can be used as it decrease the chance of myocardial infarction mainly for men but not an ideal option for women as it may cause bleeding from the stomach.

  • Amanda as a patient of high blood pressure and vascular constriction needs both primary and secondary prevention from Ischaemic heart disease. The treatment of this patient should be based on beta blockers in combination with ACE inhibitors. If the patient cannot tolerate beta blockers, then verapamil can be used. Thus in case of Amanda, special attention should be given if aspirin has to be used. Moreover, it should be remembered that according to the epidemiological study of Finegold, Asaria & Francis (2013), the mortality rate due to Ischaemic heart disease is much higher for the patients with high blood pressure.
  • James as a patient of atherosclerosis needs special attention of medical experts. The patient needs a better control on his cholesterol level of blood because cholesterol is one of the main substances of plaque formation. In this perspective, statins should be used by James with proper attention and guidance as statins have been reported to inhibit the Vitamin K2 synthesis which is a co-factor of activation of matrix Gla- protein. This Gla- protein reduces calcification inside arteries. Thus, statins may be ineffective (Finegold, Asaria & Francis, 2013).

          It can be clearly said that high blood pressure, vascular constriction and atherosclerosis both are prominent risk factors for Ischaemic heart disease. They should follow the medical practitioner’s advice, lead a healthy lifestyle, healthy diet and should be careful when choosing the medication as they are already suffering from cardio-vascular problems (Okuyama H, 2017). Pharmacological aspects should be considered case wise as Amanda and James are suffering from two different health problems.

 

Reference List:

Cardiovascular diseases top Australian health care spending (AIHW). (2017). Aihw.gov.au. Retrieved 22 March 2017, from https://www.aihw.gov.au/media-release-detail/?id=60129546452

Coronary heart disease and atherosclerosis. (2017). Healthdirect.gov.au. Retrieved 22 March 2017, from https://www.healthdirect.gov.au/coronary-heart-disease-and-atherosclerosis

Del Brutto, O. H., Peñaherrera, E., Ochoa, E., Santamaría, M., Zambrano, M., & Del Brutto, V. J. (2014). Door?to?door survey of cardiovascular health, stroke, and ischemic heart disease in rural coastal Ecuador–the Atahualpa Project: methodology and operational definitions. International journal of stroke, 9(3), 367-371.

Department of Health | Cardiovascular disease. (2017). Health.gov.au. Retrieved 22 March 2017, from https://www.health.gov.au/internet/main/publishing.nsf/content/chronic-cardio

Finegold, J. A., Asaria, P., & Francis, D. P. (2013). Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. International journal of cardiology, 168(2), 934-945.

Foundation, T. (2017). Coronary heart disease CHD. The Heart Foundation. Retrieved 22 March 2017, from https://www.heartfoundation.org.au/your-heart/heart-conditions/coronary-heart-disease-CHD

Mann, D. L., Zipes, D. P., Libby, P., & Bonow, R. O. (2014). Braunwald's heart disease: a textbook of cardiovascular medicine. Elsevier Health Sciences.

Okuyama H, e. (2017). Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 22 March 2017, from https://www.ncbi.nlm.nih.gov/pubmed/25655639

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