FEATURE


to pump the blood around the body. This can cause fluid to build up around the lungs, making it increasingly difficult for the patient to breath. This heart failure can happen suddenly (acute heart failure) or gradually over time (chronic heart failure). [5]


The


number of people currently living in Northern Ireland with heart failure is 15,142, which is equivalent to 1% of the population. [1]


Causes of CHD Smoking is a major risk factor for CHD – both nicotine and carbon monoxide put a strain on the heart by making it work faster, these substances can also increase your risk of developing inappropriate blood clots. Other chemicals in cigarette smoke can damage the lining of the coronary arteries, increasing the risk of atherosclerosis and atheroma development.


High blood pressure puts unnecessary strain on the heart also, and can lead to CHD – high blood pressure is defined as a systolic pressure (top number) of >140mmHg, or a diastolic pressure (bottom number) >90mmHg.


There are a number of useful resources, available online that will detail low, medium, and high blood pressure readings – what these may mean, and what should be done. [6] It should be noted that a one off reading does not necessarily mean a patient has hypertension – blood pressure readings should always be interpreted in the context of the situation, for example a person’s blood pressure will naturally be higher shortly after exercise.


tends to be more severe. Often a patient will experience:


• An extreme tightness across the chest


• Chest pain, perhaps radiating to other parts of the body, arms, jaw, neck, back, and abdomen


• Lightheadedness • Sweating • Nausea • Breathlessness


Unlike angina, the symptoms of a heart attack are not usually relived by a nitrate medicine, and will usually last longer than 10 minutes. In some instances heart attacks can happen with out any apparent symptoms, and is known as a silent myocardial infarction.


Heart failure can also occur in patients suffering from CHD when the heart muscles become too weak


Cholesterol is a fat produced in the liver and is essential for the survival of healthy cells, however when levels of cholesterol in the blood become too high this can increase a person risk of developing CHD. Cholesterol is a carried in the blood by lipoproteins, of which there are many types – the main two of concern here are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). For healthy living, a person needs a certain amount of both types, LDL & HDL circulating in the bloodstream. LDL is often called “bad cholesterol”, and it transports cholesterol from the liver to other cells – too much of this process, and cholesterol tends to build up on the walls of arteries. HDL is often called “good cholesterol”, and it carries cholesterol away form the cells and back to the liver.


Current government guidelines recommend that total cholesterol levels be: • 5 mmol/L or less for healthy adults • 4 mmol/L or less for those at high risk


Levels of LDL should be: • 3 mmol/L or less for healthy adults • 2 mmol/L or less for those at high risk


An ideal level of HDL is above 1 mmol/L, as a lower level of HDL can increase the risk of a person developing heart disease. [7]


How is CHD treated? Some of the most effective CHD treatments include the alteration of patient lifestyle choices. For people who smoke – choosing to stop smoking will rapidly reduce their risk of having a heart attack in the future, close to that of a non-smoker.


Choosing to eat more healthily and doing regular exercise will also significantly reduce their risk of developing heart disease. These lifestyle factors are some of the most effective methods of reducing a person risk of developing CHD, however requires the motivation of the patient to see through fully such changes in habits.


As a healthcare provider, it is important to make the patient aware of their current risks, and what they can do to reduce these risks. Similarly, when a patient is informed about their options and the impact their lifestyle choices are having on their health – they may be more likely to take positive steps to help reduce their risk of developing CHD.


There are many medicines available to help treat the various factors at play in CHD – too many to cover in this article. The following are a list of some of the most commonly used types of medicines.


• Antiplatelets (aspirin, clopidogrel) – reduce the risk of developing a heart attack by reducing the bloods ability to clot. • Statins – reduce the amount of cholesterol produced and reducing the number of LDL receptors in the liver. • Beta-blockers (bisoprolol, atenolol, metoprolol) – act on beta-receptors in the heart muscle to slow the heartbeats and improve blood flow. • Nitrates – cause vasodilation, relaxing the blood vessel walls and allowing more blood to pass through them. • Angiotensin-converting enzymes (ACE) inhibitors (lisinopril, Ramipril) – block the activity of the hormone angiotensin II, which causes the blood vessels to narrow. ACE inhibitors also improve the flow of blood around the body. • Angiotensin II receptor antagonists – similarly, blocks the action of angiotensin II, lowering blood pressure. • Calcium channel blockers (amlodipine, verapamil, diltiazem) – these agents act on calcium channels resulting in a reduction in blood pressure. • Diuretics – sometimes called a water tablet, work by flushing excess water and salt from the body, through the production of urine.


These medicines may be used in combination or in isolation, and each of which can have undesirable effects. Some of the medicines that can be purchased over the counter in a pharmacy can also affect the way these medicines behave within the body and as such, care should always be taken when providing over the counter advice.


It is always good practice to ask the patient if they take any medicines, and taking the time to consider the impact any over the counter medicines might have on the patient, when taken alongside a patient’s current medicine.


Community pharmacy has become an ideal place for patients to discuss their medicines, therapies, and lifestyle factors associated with health, with a member of the healthcare team – one who is now most suited to provide medicines advice.


With the increased awareness of cardiovascular health, and improvement in patients choosing the most appropriate healthcare setting for their concerns to be dealt with – patients are increasingly visiting their community pharmacies, before booking to see their GP.


To meet this need, pharmacists and pharmacy staff need to be able to provide accurate information, so that patients can be informed about their health, and ultimately be advised as to what are the most appropriate next steps for them. n


References: 1. Data tables on deaths registered in NI in 2014. Available: http://www.nisra.gov.uk/archive/demography/pu blications/births_deaths/deaths_2013.pdf. Accessed: 8/10/15


2. Prevalence data in the Quality and Outcomes Framework Disease Prevalence (2014/15 data). Available: http://www.ninis2.nisra.gov.uk/public/Theme.as px?themeNumber=134&themeName=Health+a nd+Social+Care. Accessed: 8/10/15


3. National Health Service Coronary Heart disease Website. Available: http://www.nhs.uk/conditions/Coronary-heart- disease/Pages/Introduction.aspx. Accessed: 08/10/15.


4. Hospital Inpatient System 2013/14. Admissions are estimated using discharge episodes, stroke and heart attack is identified using the International Classification of Disease (version 10) codes. Available: http://www.nichs.org.uk/666/statistics-about- chest-heart-and-stroke-conditions. Accessed 08/10/15.


5. National Health Service Coronary Heart disease Website. Available http://www.nhs.uk/Conditions/Coronary-heart- disease/Pages/Symptoms.aspx. Accessed: 08/10/15.


6. Blood Pressure UK website. Available: http://www.bloodpressureuk.org/Home . Accessed: 08/10/15.


7. National Health Service Coronary Heart disease Website. Available: http://www.nhs.uk/Conditions/Coronary-heart- disease/Pages/Causes.aspx. Accessed: 08/10/15.


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