FEATURE


Heart failure can also occur in patients suffering from CHD when the heart muscles become too weak 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). 4


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. 5 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.


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 persons risk of developing CHD. Cholesterol is 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 level are:


< 5 mmol/L for healthy adults < 4 mmol/L for those at high risk Levels of LDL should be: < 3 mmol/L for healthy adults < 2 mmol/L 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. 6


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 persons risk of developing CHD, however it 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. A list of some of the most commonly used medicine classes and their mode of actions are described in Table 1 below.


These medicines may be used in combination or in isolation, each of which can have undesirable effects. Some of the medicines that can be purchased in a pharmacy, or in local stores 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


Table 1: Commonly prescribed medicine classes, and their mode of action, for the treatment of CHD in Scotland. Medicine class


Action


Antiplatelet Statins


Beta-blockers Nitrates


Angiotensin-converting enzymes (ACE) inhibitors


Angiotensin II receptor antagonists


Calcium channel blockers (CCB)


Diuretics 18 - SCOTTISH PHARMACIST Lower the risk of developing a heart attack by reducing the bloods ability to clot


Reduce the amount of cholesterol produced, and reducing the number of LDL receptors in the liver


Act on beta-receptors in the heart muscle to slow the heartbeats and improve blood flow


Cause vasodilation, relaxing the blood vessel walls and allowing more blood to pass through them


Block the activity of the hormone angiotensin II, which causes the blood vessels to narrow, they also improve the flow of blood around the body


Blocks the action of angiotensin II lowering blood pressure Act on calcium channels resulting in a reduction in blood pressure


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 - as pharmacists we are 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. •


REFERENCES:


1. Heart research institute UK website. Available: http://www. hriuk.org/about-heart-disease/ Scotland/. Accessed 29/10/15


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


3. Statistics of the British Heart Foundation, Scotland. Available: https://www.bhf.org.uk/scotland/. Accessed 29/10/15.


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


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


6. National Health Service Coronary Heart disease Website. Available:


http://www.nhs.uk/Conditions/ Coronary-heart-disease/Pages/ Causes.aspx.


Flush excess water and salt from the body, by the production of urine Accessed: 08/10/15.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56