Cardiovascular Disease Mini Case Study
Lindsey B. Jernigan
Cardiovascular Disease Mini Case Study
Cardiovascular disease is the leading cause of mortality worldwide (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). According to the World Health Organization (WHO), cardiovascular disease is the cause of approximately 17 million deaths annually. Cardiovascular diseases include hypertension, heart failure, coronary artery disease, and myocardial infarction (National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2012). Prevention and management of cardiovascular risk factors can reduce overall morbidity and mortality (Fuster & Kelly, 2010). Several risk factors are associated with an increased incidence of cardiovascular disease including cigarette smoking, hypertension, physical inactivity, high-fat diets, and dyslipidemia (Buttar, Li, & Ravi, 2005).
The most preventable cause of death and disease in Americans is tobacco use. It is estimated that almost 40 percent of the approximately half a million deaths from cardiovascular disease each year can be attributed to smoking (Halpin, Morales-Suárez-Varela, & Martin-Moreno, 2010). Research has shown that smoking accelerates hardening of the arteries, arteriosclerosis, and fatty deposits in the artery walls, atherosclerosis, increasing the risk of heart disease, stroke, and peripheral vascular disease. Smoking increases blood levels of fibrinogen, a clotting component of blood, which may increase the possibility of the formation of blood clots which can block the coronary arteries, predisposing the patient to a heart attack or stroke (Zahler & Piselli, 1992). Smoking cessation programs are typically offered within the community setting, some for little or no cost. A smoking cessation program, as one form of intervention, should be encouraged to this patient as it reduces the risk of heart disease and stroke and improves their overall health (Buttar et al., 2005).
Hypertension is the greatest risk factor that affects Americans today. The American Heart Association and the National Heart, Lung, and Blood Institute estimate that 55–60 million Americans have high blood pressure. Hypertension is generally defined as blood pressure readings that are consistently above 140/90 mmHg or a single reading that is extremely high (Moser, 1992). For this patient in particular, blood pressure should be monitored consistently and treated as necessary to prevent further complications of cardiovascular disease. Antihypertensive medications can be prescribed for the patient to lower blood pressure and drastically reduce the increased risk for complications related to cardiovascular disease (Black, 1992).
Physical inactivity is an important risk factor for cardiovascular disease, and is associated with a increased incidence of coronary artery disease, high cholesterol levels, obesity and hypertension. It can reduce the likelihood and severities of a heart attack should one occur. Regular exercise can lower cardiovascular disease associated risk and should be encouraged, within individual limits, at all ages (Wackers, 1992). It is recommended that children and adolescents get at least 60 minutes of physical activity per day. Adults 65 years and older, who have no limiting health conditions, should be moderate to vigorously active at least 150 minutes per week for at least 10 minutes at a time (Halpin et al., 2010). The patient should be instructed on an appropriate exercise regimen to help lower added cardiovascular risks and to help maintain an appropriate weight. Instruct the patient to begin with a low-intensity exercise program or refer the patient to a cardiac rehabilitation program (National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2012).
It is shown that the ratio in which different dietary fats are consumed is directly proportionate to blood concentrations of HDL and LDL (Buttar et al., 2005). It is recommended that the daily total fat intake should be less than 30% of the total calories for the day. Specifically saturated fat needs to account for less than 10% of calories, dietary fat should be polyunsaturated, up to 10% of calories, or monounsaturated, 10–15% of calories, and transfatty acids should be reduced or eliminated if possible (World Health Organization, 2007). In a recent study reported by Buttar, Li, & Ravi (2005) it showed that the incidence of cardiovascular events decreased by 42% when 5% of the daily intake of saturated fats were replaced with unsaturated fats (Buttar et al., 2005). Daily salt intake should also be reduced to less than three grams per day, which will positively affect elevated blood pressure (World Health Organization, 2007). The patient should be instructed on and encouraged to maintain a heart healthy diet low in fat content and sodium. Encourage the increase of fresh fruits and vegetables in their diet. To reduce salt intake, advise the patient to choose foods labeled ‘no added salt’ or ‘low salt.’ Also instruct them to avoid processed foods, salty snacks, fast foods and adding salt during cooking or at the table.
Referring the patient to a dietitian for support with dietary changes may be advisable (National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2012).
Elevated serum lipid levels, including cholesterol and triglycerides, are exceptionally common in cardiovascular disease and are one of the most important modifiable risk factors (Black, 1992). In a report by the Scottish Intercollegiate Guidelines Network (2007) actively treating patients with statins reduced the risk associated with major coronary events by 34%. Statin treatment reducing cholesterol levels by 20% would be expected to reduce coronary heart disease mortality by 30% (Scottish Intercollegiate Guidelines Network, 2007). Evaluating the patient’s cholesterol levels, calculating their specific HDL to LDL ratio, and prescribing statin therapy for the patient is recommended. Also, reinforce that exercise and diet play a very important role in reducing cholesterol levels. Determine the patient’s daily caloric intake needs (based on height, weight, gender, age, and activity level) and print specific diet information for the patient to follow including information on low-fat, heart healthy meal and snack options (Fairchild & Utermohlen, 1992).
The cardiologist should recommend a cardiac catheterization, an intervention also known as a coronary angiography, to further assess the health of the heart, determine if there is a narrowing or blockage any of the blood vessels and to establish the course of treatment (Deckelbaum, 1992).
Cardiovascular disease is the leading cause of mortality worldwide (Lopez et al., 2006). The most prevalent risk factors that increase the risk of developing cardiovascular disease, including smoking, hypertension, obesity, and hyperlipidemia, are preventable (Buttar et al., 2005). It is the responsibility of nurses and practitioners to educate patients on how they can take control of their health to prevent disease and live a healthy life.
Black, H. R. (1992). Cardiovascular Risk Factors. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 23–35). New York, NY: William Morrow & Co.
Buttar, H. S., Li, T., & Ravi, N. (2005). Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation. Experimental and Clinical Cardiology, 10(4), 229–249. Retrieved on September 23, 2014, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2716237&tool=pmcentrez&rendertype=abstract
Deckelbaum, L. (1992). Heart Attacks and Coronary Artery Disease. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 133–148). New York, NY: William Morrow & Co.
Fairchild, M., & Utermohlen, V. (1992). Adopting a Healthful Diet. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 51–70). New York, NY: William Morrow & Co.
Fuster, V., & Kelly, B. B. (2010). Promoting Cardiovascular Health in the Developing World. Washington; DC: National Academies Press.
Halpin, H. A., Morales-Suárez-Varela, M. M., & Martin-Moreno, J. M. (2010). Chronic Disease Prevention and the New Public Health. Public Health Reviews, 32(1), 120–154.
Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. (2006). Global and regional burden of disease and risk factors 2001: Systematic analysis of population health data. Lancet, 367, 1747–1757.
Moser, M. (1992). High Blood Pressure. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 149–166). New York, NY: William Morrow & Co.
National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. (2012). Reducing risk in heart disease: An expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia.
Scottish Intercollegiate Guidelines Network. (2007). Risk estimation and the prevention of cardiovascular disease: A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network.
Wackers, F. J. (1992). Exercise. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 85–94). New York, NY: William Morrow & Co.
World Health Organization. (2007). Prevention of Cardiovascular Disease: Pocket Guidelines for Assessment and Management of CVD Risk (pp. 1–30). Geneva.
Zahler, R., & Piselli, C. (1992). Smoking, Alcohol, and Drugs. In B. L. Zaret, M. Moser, & L. S. Cohen (Eds.), Yale University School of Medicine Heart Book (pp. 71–83). New York, NY: William Morrow & Co.