A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
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Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
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Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
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Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
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If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
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Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
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Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
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The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
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Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
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A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
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1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
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1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
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Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.