More than one in four deaths occurs because of heart disease, according to the Centers for Disease Control and Prevention (CDC). Heart disease is the leading cause of death in the United States for both men and women. Every year approximately 785,000 Americans have their first heart attack. There are guidelines for treatment that can reduce the mortality associated with heart disease.
Angina
According to the "5-Minute Clinical Consult" textbook, almost seven million people suffer with angina and the prevalence increases with age. Angina is chest pain or pressure that results when the coronary arteries are blocked. Blood flow to the heart muscle is diminished thus decreasing the amount of oxygen the heart receives. Angina can be brought on by exertion, stress, meals, cold air or smoking. According to the "5-Minute Clinical Consult" textbook, first line of therapy in angina is to use aspirin 81 to 325 mg daily with a beta blocker such as metoprolol 25 to 100mg daily, that will slow the heart rate and reduce the oxygen demand of the heart thereby reducing angina. Patients may also benefit from nitroglycerin 0.4mg under the tongue when they feel the beginning of chest pain. This can be repeated every 10 to 15 minutes up to three times for relief. Nitroglycerin dilates the coronary arteries which increases blood flow.
Coronary Artery Disease (CAD)
CAD is caused by arteriosclerosis or thickening and loss of elasticity of the coronary arteries and atherosclerosis or the fatty deposits inside the arteries. Atherosclerosis and arteriosclerosis cause blockage of blood flow. Patients with CAD should be placed on a daily aspirin 160 to 325 mg or clopidogrel 75 mg daily if aspirin is contraindicated to prevent clots from forming. An ACE inhibitor such as lisinopril will help keep blood pressure controlled, particularly for diabetic patients. To reduce the further build-up of plaque the use of cholesterol lowering agents such as simvastatin or atorvastatin is recommended by the "5-Minute Clinical Consult" textbook. The use of cholesterol lowering statin drugs can also decrease the inflammatory response of the arteries.
Congestive Heart Failure
Congestive heart failure occurs when the heart has been damaged and can no longer pump blood effectively. This causes fluid backup into the lungs and the rest of the body causing shortness of breath, cough, and swelling of the feet and ankles. ACE inhibitors such as lisinopril are used to dilate the arteries so that the heart does not have to work as hard to pump. According to the "5-Minute Clinical Consult" textbook, ACE inhibitor have been shown to increase survival, improve symptomatology and improve exercise endurance. Diuretics such as furosemide 20 to 80 mg orally each day or metolazone 2.5 to 20 mg daily can help with excess fluid. The diuretic spironolactone 12.5 to 25 mg daily is the only diuretic shown to reduce mortality.
References
- "5-Minute Clinical Consult 2010." Frank J. Domino, MD Editor. 2009
- Centers for Disease Control and Prevention.gov: Heart Disease Facts
