FEATURE
The role of Pharmacy in Cardiovascular Disease Management
C
oronary heart disease (CHD), also sometimes referred to as ischaemic heart disease, is the
leading cause of death in Scotland and worldwide; the positive news is that mortality rates for premature deaths from CHD in Scotland has fallen by more than one third since 1995. Despite this CHD remains Scotland’s biggest killer, now accounting for 18,500 deaths each year. 1 It is estimated that 620,000 people are currently suffering from heart disease in Scotland. 1 As one of the top killers, in terms of manageable chronic conditions, it is of utmost importance that Pharmacy staff are knowledgeable about the condition and able to provide advice and guidance, specifically in terms of medicines, but also regarding therapies and strategies that can be effective in managing the progression of this disease.
WHAT IS CHD?
CHD is a term that describes what happens when the hearts own blood supply is interrupted or blocked.
16 - SCOTTISH PHARMACIST
This interruption or blockage can be caused by a build-up of fatty substances in the coronary arteries (arteries which supply the heart). Over a prolonged period of time, these arteries can become coated with fatty deposits, called atheroma - this process is known as atherosclerosis. 2 Atherosclerosis results in the arteries becoming narrow and hard, and results in a restricted blood flow to the heart. If one of these plaques (coatings) ruptures or fragments, this can cause a blood clot. In turn, this blood clot can block the blood supply to the heart, causing a heart attack, or it can block the blood supply to the brain, causing a stroke. Atherosclerosis can be caused by other heath conditions and is heavily influenced by lifestyle factors such as: smoking, high blood pressure, high cholesterol, and diabetes.
The most common symptoms of CHD are chest pain (angina) and heart attacks, however heart palpitations and irregular breathlessness can be indicators of the condition. In some instances the patient may
be completely asymptomatic prior to receiving a diagnosis. Angina is a condition, which develops from partially blocked arteries, and so there is reduced blood flow to the heart. This can be experienced as a mild and uncomfortable feeling, not dissimilar to indigestion. However, in severe cases of angina an extremely painful feeling of heaviness or tightness, usually across the centre of the chest, which may spread to the arms, neck, jaw, back or stomach can be experienced. Angina can be triggered by physical activity or stressful situations – the symptoms usually pass within 10 minutes, and can be relived using a nitrate preparation, commonly administered in the form of a sub-lingual (under the tongue) pump spray.
If the arteries supplying the heart of blood become fully blocked or obstructed, this is known as a myocardial infarction (heart attack). This is a medical emergency and medical assistance should be sought. The cost of heart disease to the health care system in the UK is estimated
at £3.2 billion each year. This in turn has an impact on the economy as a whole, with estimates of £9 billion each year when accounting for the cost of lost days at work, death, and care of people with heart disease. 3 Heart attacks can permanently cause damage to the heart muscle, and if not treated quickly, can be fatal. Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina, but tends to be more severe. Patients will often experience: an extreme tightness across the chest, chest pain - perhaps radiating to other parts of the body such as the arms, jaw, neck, back, and abdomen. Patients can also suffer lightheadedness, sweating, nausea, and 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 without any apparent symptoms, and is known as a silent myocardial infarction.
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