Coronary Artery Disease
Blood flowing into the heart may be limited by the diseases that affect the arteries leading to ischemia. Ischemia means cell starvation, which is secondary to the insufficient oxygen in the myocardial cells. When the oxygen is supplied in the limited quantities or it is absent at all, the myocardial cells die as they only work in the presence of oxygen. The death of these cells is called heart attack or myocardial infarction. Heart attack causes damage of the heart muscle, or death of the same heart muscle. Later on, the myocardial scarring does take place and as a consequence, the heart muscle regeneration does not take place. Chronic coronary artery stenosis can lead to the transient ischemia. This kind of ischemia brings about the ventricular arrhythmia. This ventricular arrhythmia may end up as ventricular fibrillation that automatically leads to death (Underwood and Cross, 2009).
Normally, the disease of the coronary artery comes about when the inside part of the artery, which is elastic and smooth, develops atherosclerosis. Atherosclerosis causes the lining of the artery to become hardened, swollen, as well as stiffened. This hardness comes due to deposition of calcium, fats inflammatory of cells. Inflammatory of cells brings about plaque. Hydroxyapatite, which simply means deposits of calcium phosphate layer in the artery lining, plays a notable role in the artery hardening. Hydroxyapatite induces the early coronary arteriosclerosis. The arteriosclerosis can be noted in the mechanism of metastatic of calcification just in the way it occurs in the so-called chronic disease of the kidney and hemodialysis. Despite the fact that the patients suffer from renal failure, over fifty percent of such patients lose their lives because of coronary artery disease. Plaques can be described as some forms of pimples which protrude within the channel of the arteries. The protrusions partially obstruct the flow of blood through arteries causing limitations in the supply of blood into the heart. Usually, patients who have the disease of the coronary artery may have it in a single artery, or even have the same problem all over their coronary arteries. There is also something worth noting when it comes to the disease, which is called cardiac syndrome X. Cardiac syndrome X is described as chest pain, also called Angina Pectoris. The cardiac syndrome X causes much pain to those patients who have no indicators of blockages within those large coronary arteries during the performance of the angiogram in their hearts.
The causative factor of cardiac syndrome X remains unknown. It can, however, be explained in a number of ways. The first way it can be explained is the microvascular dysfunction. There is one thing, which remains unclear as to why women mostly suffer from this dysfunction compared to men. Maybe this problem can be attributed to the difference that occurs in women in terms of hormones, which is unique.
The common sign that can attribute to the presence of coronary artery disease is the chest pain, also called angina. Angina symptoms can be pressure, burning, aching, numbness, painful feeling, heaviness or squeezing. It is usually mistaken to be a heartburn or indigestion. Angina is experienced in the chest, arms, left shoulder, neck, jaw or back. There are also some other symptoms that can be attributed to angina: nausea, breath shortness, abnormal heartbeat, palpitations, as well as sweating.
There are three treatment options for coronary artery disease: medical treatment, which includes drugs that aid in cholesterol lowering, calcium antagonists, nitroglycerine and beta-blockers. The second treatment option is the coronary interventions like the coronary stent and angioplasty. The last way of managing the coronary disease is the bypass grafting of the coronary artery.
There are some kinds of lifestyles that are to be practiced and have been scientifically proved to be somewhat effective in the reduction of the coronary disease levels. Also, the case of diet is so effective that it reverses the coronary artery disease. Such lifestyles are: weight control, food diet, smoking cessation, total avoidance of trans-fats consumption. Aerobic exercise like jogging and swimming leads to reduction of blood pressure, as well as blood cholesterol content with time. Exercise also has the effect of raising the level of HDL cholesterol. This type of cholesterol is said to be a good one since it does not have a negative effect on the body of a man. In the people who have coronary artery disease, the risk connected to mortality can be limited by aerobic exercise. However, it cannot be clearly said that medical doctors should in all occasions spend time counseling their patients to do exercise or not. The US Preventive Services Task Force did not find any worthy evidence that could be necessarily used in recommending doctors to advice their patients to make use of exercise as a way of controlling the coronary artery disease.
Statins can be used in reduction of cholesterol and thus reducing the coronary disease risk of infection. ACE inhibitors treat hypertension and so, may bring down the myocardial infarction recurrent (Awtry, 2004). Aspirin is also used in the medication of coronary artery disease. For the patients who do not experience other problems of the heart, aspirin has the effect of reducing the myocardial infarction risk that occurs majorly in men. It however cannot be used to help the women. Aspirin is only recommended for those adult men who stand a death risk due to the coronary artery disease. Men who need the aspirin assistance are those of ninety years and above. Women at menopause stage and young persons at coronary artery disease risk groups, such as diabetes, smoking and hypertension also can use aspirin.
Antiplatelet therapy clopidogrel combined with aspirin has more effect on reducing cardiovascular diseases than aspirin used alone in the patients with STEMI.
Percutaneous Coronary Intervention and Medical Therapy
Percutaneous Coronary Intervention is more effective compared to the medical therapy in discharging angina. However, it confers no better survival benefit. Serious lipid-lowering therapy is effective like Percutaneous Coronary Intervention in addition to the normal medical care in limiting the cases of ischemic attacks.
Coronary Artery Bypass Grafting Versus Medical Therapy
Coronary artery bypass graft in some circumstances has better survival levels than the medical therapy, thus is recommended for those patients with symptoms of left coronary artery disease. The Coronary artery bypass graft surgery is more effective compared to the medical therapy in treatment of angina, even though the benefit narrows after duration of five to ten years, mostly due to advancing of coronary artery disease in the native vessel plus vein graft attrition.
Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting
The outcomes, which were a result of percutaneous coronary intervention, as well as Coronary artery bypass graft, have been referenced to the patients at high risk. Percutaneous coronary intervention is usually limited to angioplasty. Likewise, the current techniques of CABG, which include the more frequent technique of arterial conduits, are not part of the percutaneous coronary intervention. When it comes to relieving angina, there is a form of treatment that is better, and it is therefore preferred by the medical doctors. A percutaneous approach has been found out, in which the coronary artery disease is shifting away. This kind of shift is vital as it is a combination of drug-eluting stent and catheterization techniques that are improved. There is high reduction or lowering of the restenosis rates, as well as the acute complications that are thrombotic due to advances in the area of antiplatelet therapy (Awtry, and Loscalzo, 2004).
Changes in monitoring of respiratory functions include the observation of patients to look for signs relating to respiratory distress. Such monitoring helps to identify the signs early enough so that the medical doctors would be able to intervene. Early intervention can save many people as a patient would not have to suffer too much. The sputum is to be thoroughly checked so that any odor or change in color is seen and addressed in time. Another intervention is suctioning that is done in order to make sure that the airways of the patient are maintained. This suctioning is done through placing the patient in a position, in which he or she will be facilitated to drain, thus limiting aspiration. It is also done by installing lidocaine in endotracheal tube,thus minimizing the intracranial pressure rise due to suctioning. Oxygenation of a patient just before suctioning is important on the physicians approval. Catheter insertion should be limited so that the amount of carbon IV oxide does not rise at all. This activity should take place for a period that is at least fifteen seconds (Jameson, 2005).
Respiratory intervention can also be done through the use of an Ambu bag in a periodic manner so that the lung tissue can be inflated. At the same time, supplementary oxygen has to be administered. This process is done by provision of tracheostomy in every four to eight hours each day. Maintaining of the inflated cuffs is paramount on the tracheostomy tube than making adjustment of ventilation system. Another thing that has to be done here is the application of stockings, or sequential-compression boots in order to stop pulmonary emboli.