Cardiovascular Diseases In Australian Aboriginal Population – The Association Hypertension, Smoking, And Obesity In The Development Of Heart Failure Online Tutoring
Cardiovascular systems involve heart and blood vessels. This is the vital system that is responsible for pumping blood to vital organs of the body, including the lungs where the carbon dioxide is replaced by oxygen. The oxygenated blood is pumped into the systemic circulation and receives unoxygenated blood that is again pumped towards the lung for the same motto (Ponikowski et al., 2014). Pathology of cardiovascular systems involves the pathology of heart and blood vessels that usually compromises the function of the cardiovascular system, which is to pump blood to different parts of the body (Kachur et al., 2017). Some of the pathologies are arteriosclerosis, atherosclerosis, ischemic heart diseases (acute coronary syndromes and myocardial infarction), stroke, hypertension, and valvular heart diseases, etc. The etiologies of all these lousy health conditions involving cardiovascular systems are interrelated (Nordahl et al., 2014). In the Australian population, the prevalence of heart diseases in the indigenous population is greater than the emigrants. Several factors have been reported for causing this. This gap is reported to be caused by modifiable risk factors (Zhao & Dempsey, 2006). A few of these factors are the genetic propensity to develop heart diseases, lack of enough physical activity, and smoking (Amiri et al., 2019). Ethnicity plays a part as far as the prevalence of cardiovascular ailments in the Australian population is concerned. All of these risk factors are points of concern for the healthcare teams, and constant heed should be paid to get rid of the imminent propensity to become a victim of cardiovascular disease if you are an Australian aboriginal (Skilton et al., 2011).
Hypertension is a malignant disorder involving the whole of the vascular system. This increases the risk of arterial rupture, arteriosclerosis, fibrinoid necrosis of the vessels, vision loss, stroke, heart failure, and myocardial infarction. While obesity, aging, worries, high salt intake, diabetes, and male gender increases the risk of development of hypertension (Taylor et al., 2011). Smoking exposes the human body to several chemicals that enhance the chances of development of hypertension, blood clotting, hypoxia to the heart muscle, and heart attack, etc. Over-weight, increased body-mass index, and obesity markedly increases the risk of the propensity to develop cardiovascular disease, ischemic heart diseases, atherosclerosis, diabetes, and hypertension (Amiri et al., 2019). The close relationship between the etiologies of these diseases lay the foundation for the development of the other cardiovascular condition in the presence of the one. The propensity to develop heart and vessel disorders multiplies in the existence of comorbid conditions. If hypertension exists in a patient already overweight, the risk of development of high-risk diseases like ischemic heart disease and diabetes increases to many folds (Ettehad et al., 2018). Obesity leads to the early onset of diabetes mellitus that, in turn, increases the risk of hypertension, hypercoagulability, clot formation, atherosclerosis, and atherosclerosis. These microangiopathies, combined with 0macroangipahties, precipitate the formation of clots in major blood vessels in the heart and brain, leading to stroke, angina, and myocardial infarction. Ischemia of the myocardium leads to the necrosis of heart tissue. Death of heart muscle cells ensues fibrosis. The heart muscle and tissue get fibrosed, and pumping of the heart is significantly compromised, leading to heart failure (Nordahl et al., 2014).
Obesity increases the need for oxygenated blood to meet the increased demand by the body. To compensate for the requirement, the blood pressure rises so that blood percolates throughout the body. This perfectly sets up the condition for the development of hypertension (Banegas et al., 2011). Obesity involves dyslipidemia. The abnormal levels of fats and lipoproteins are called dyslipidemia. High triglyceride, intermediate-density lipoprotein, low-density lipoprotein levels are dangerous for the body. Cholesterol carried by these lipoproteins damages the blood vessels. Fatty acids released by fats get oxidized, and such oxidized fats are engulfed by the macrophages in the blood vessels. These macrophages get filled with oxidizes fats, and these cells are known as foam cells (Banegas et al., 2011). Foam cells accumulate in tunica media of the blood vessels, The affected vessel, in turn, balloons out in the lumen, thus constricting the vessel and impeding the blood flow. This process is labeled under atherosclerosis characterized by plaque formation. Such plaque also damages the vessel’s endothelial lining, exposing the hypercoagulable molecules to the blood. This damage recruits signaling molecules, proteins, and platelets to form a thrombus or blood clot. This blood clot also impedes the blood flow causing hypoxia and ischemia. These clots usually are sessile. Sometimes, this clot gets dislodged due to blood pressure and moves in the blood vessel, along with the blood flow. This is called an embolus. Emboli usually occlude distant vessels, including some vital vessels like pulmonary arteries and coronary arteries (Ponikowski et al., 2014). Occlusion of the pulmonary artery increases blood pressure in the pulmonary circuit and increases the load on the right side of the heart leading to right-sided heart failure. Signs and symptoms of right-sided heart failure include edema, hypoxia, fatigue, shortness of breath, heart muscle pain, and engorgement of neck veins. Occlusion of the coronary artery causes chest pain or angina. Lack of blood flow to the heart muscle leads to severe stabbing pain in the pericardium radiating to the left hand, arm, and jaw (Melenoovsky et al., 2014).
Smoking is not only injurious to the human lungs, but it poses certain grave threats to the cardiovascular system that can not be ignored. Smoking tobacco increases the levels of nicotine, polyvinyl carbons, naphthalenes, and benzene ring compounds in the blood. These chemicals are not only carcinogenic but also cause blood vessels to become less flexible and rigid. Smoking mainly affects blood vessels in the cardiovascular system, producing a number of diseases of blood vessels. Smoking causes atherosclerosis, in which the lumen of the arteries and veins constricts, rendering them less flexible. It takes place when cigarette smoke, lipids, cholesterol, and other substances in the blood form plaque that forms in the walls of arteries (Nordahl et al., 2014). The occlusion of blood vessels resulting from atherosclerosis is the cause of anoxia, nutritional deficit to the tissues, and ischemia. The opening inside the arteries narrows as plaque grows in size, taking up significant space of the lumen, so that blood can no longer reach various parts of the body. As stated earlier, smoking increases the formation of plaque in blood vessels. Smoking increases the incidence of coronary heart diseases (Amiri et al., 2019). Coronary Heart Disease occurs when arteries that carry blood to the heart muscle are narrowed by plaque or blocked by clots. Cigarette smoke includes such compounds that cause the blood thickening, setting up a hypercoagulable state and form clots inside veins and arteries. This happens due to greater activation of components of the coagulation cascade and platelet activation. A blockage from a clot can lead to a heart attack and sudden death. Stroke is seen more often in adults who are smokers or exposed to the smoke (passive smokers). Stroke is the occlusion of a blood vessel supplying the brain tissue resulting in the loss of brain function caused when blood flow within the brain is interrupted. The brain is a vital organ that is very sensitive to hypoxia and ischemia (Nordahl et al., 2014). Neurons can barely withstand anoxia for twenty seconds after this; the neurons begin to die. Thus, strokes can cause irreversible brain damage and death of the individual. Various studies show that the deaths occurring from strokes are more likely among smokers than among former smokers or people who have never smoked. There exists a vivid relationship between cigarette smoking with Peripheral Arterial Disease (PAD) and peripheral vascular disease. These diseases arise when blood vessels become narrower, and the flow of blood to the body parts like face, head, arms, legs, hands, and feet is reduced. Cells and tissue are deprived of needed oxygen when blood flow is reduced, known as hypoxia (Lu, Makay & Pell, 2014). Severe cases of ischemia are also seen in peripheral arterial disease caused by smoking. Among the standard non inherited and preventable causes of peripheral vascular disease, smoking is the most important one. Smoking also decreases the compliance of the blood vessels, making them more prone to develop an aneurysm (Amiri et al., 2019). Aneurysms are the balloon-like dilatation of the blood vessels due to the weakening of the vessel wall. Vessel aneurysm increases the risk of vessel rupture and dissection. Vascular dissection is the separation of the layers of the vessel due to blood tearing of the tunica intima and the blood oozing into the deeper layers and forcing the layers apart. Abdominal Aortic Aneurysm is a bulge or weakened area that occurs in the portion of the aorta that is in the abdomen (Keisler & Carter, 2015). Aortic damage predisposes an individual to develop an aneurysm. The aorta is the main artery that carries oxygen-rich blood throughout the body (Aune et al., 2018). Smoking is an established cause of early damage to the abdominal aorta, which can lead to an aneurysm (Keisler & Carter, 2015). A ruptured abdominal aortic aneurysm is life-threatening; almost all deaths from abdominal aortic aneurysms are caused by smoking. Ruptured aneurysms cause severe hemorrhage in the abdomen with the pooling of blood in the abdomen (Aune et al., 2018). This quickly leads to hemorrhagic shock and cardiac arrest. Women smokers have a higher risk of dying from an aortic aneurysm than men who smoke. The autopsy findings of such individuals reveal that early narrowing of the abdominal aorta occurs in young adult smokers who started smoking at earlier ages (Keisler & Carter, 2015).
To conclude, cardiovascular ailment higher in Australian aboriginals is an alarming situation. All these causative factors like obesity, hypertension, and smoking are modifiable risk factors, and preventions of these factors will save the population from developing severe debilitating heart problems.
Self Management of Heart failure by heart patients:
Heart disease is a critical condition that requires continuous care. Heart patients are particularly vulnerable to stress, trauma, exertion, and fatigue. They should maintain their health in order not to deteriorate their health (Ponikowski et al., 2014). Prevention of further heart attack is the goal as far as self-care of the patient is concerned. The patients should be able to administer self-care to reduce hospitalizations. When the heart muscle gets damaged, the pain causes severe distress in the patient. Controlling an acute episode of ischemia to the heart can surely prevent myocardial infarction and permanent heart damage. Several considerations are available that can be vital for the self-care of the heart patient. Prevention of severe episodes of angina and heart attack is an index to the increased lifetime of the patient (Farmakis et al., 2015).
Heart disease is an ailment that requires not only the special self-care by the patient but also education & awareness to prevent any adverse health condition, i.e., he must be educated to prevent any further heart attacks. In heart diseases, the blood supply is mostly compromised, and the heart muscles are weak (Ponikowski et al., 2014). Due to a lack of supply of oxygen and nutrients due to occlusion of blood vessels as seen in ischemic heart diseases or in cases of thromboembolism, the patient must be educated to manage the acute episodes of heart diseases (Farmakis et al., 2015). For example, in a patient of heart disease (post-myocardial infarction), the patient must take rest. Physical exertion demands high glucose and oxygen demand. He shouldn’t exert himself by doing exercise, or by exertion, the supply-demand for the heart muscle increases manifolds. The compromised myocardium of the heart is unable to perform its action of providing required oxygen levels to the muscles. This is a serious condition in terms that the heart deprived of oxygen is unable to pump not only to its own myocardium but also to all other parts of the body (Farmakis et al., 2015). Lack of oxygen causes the death of the heart muscle cells leading to necrosis of myocardium. He should be complying with the maximum word limit, as described in the physician’s guideline.
The patient should be educated about the use of vasodilators such as angisid or other nitroglycerine’s. Nitroglyceries are the drugs that are effective in self-management of an acute episode of angina. Vasodilatory action of these drugs is often life saving and prevent possible hospitalization of the patient. In an acute heart attack, the time delay in seeking medical assistance can be life-threatening (Farmakis et al., 2015). Self-administration of nitroglyceride can prevent any mischance. Moreover, the patient must be encouraged to use antiplatelet drugs for blood thinning. Antiplatelet drugs cause a decline in platelet activity. The thrombotic action of platelets gets arrested in a heart patient; then, there is a propensity to develop platelet thrombi is markedly reduced (Patrono et al., 2017). Such platelet thrombi may lead to the occlusion of the vessels, especially the brain vessels or coronary arteries of the heart. The platelet thrombi occlude vital blood vessels in the lungs; it compromises the oxygenation of the blood. Thrombotic events in the heart can lead to further deterioration of already weak heart muscle. This may precipitate an acute episode of heart disease.
Lifestyle modification as necessary to prevent heart diseases, and he must be educated about his diet (Sievenpiper & Lavie, 2018). Hypertension as an index to developing heart problems and atherosclerosis. So, the patient must be told to avoid a high salt diet (Ettehad et al., 2018). A high salt diet has been shown to increase the volume of plasma (Sievenpiper & Lavie, 2018). The increased plasma, in turn, increases the workload of heart leading to worsening of the condition (Taylor et al., 2011). He must be advised to use anti hypertensives for controlling his blood pressure in the optimum range. Diuretics work, and this way that they increase the urine output. Increasing the urine output decreases the body fluid levels so, the workload on the heart decreases to a significant level. The oxygen requirement of the heart also becomes optimum to a level that the patients can bear (Khow et al., 2014).
Aspirin especially has anti-inflammatory and antiplatelet action. The patient should be advised to take the prescribed dose of Aspirin daily (Bibbins-Domingo, K., 2016). He should be keeping a tablet of nitroglycerin always rides with him so that in case of an acute myocardial infarction attack. He can self administer the medicine sublingually; these medicines work on the principle that they dilate the veins decreasing the venous return to the heart.
Beta-blockers are the drugs that are used to decrease the heart rate, and the patient, if prescribed, should take these drugs according to the prescription, but care should be taken in case the patient is diabetic, or he suffers from asthma. The patient must also be advised not to stop the administration of beta-blockers at once. The withdrawal of beta-blockers causes severe tachycardia or increases the heartbeat and causes palpitations. To avoid this, the patient must be advised to taper off the dose of beta-blockers to avoid any withdrawal symptoms (Ponikowski et al., 2014).
The patient should avoid fatty foods to prevent high cholesterol levels (Banegas et al., 2011). The patient must go through physical examination and should maintain his body-mass index at normal levels. Normal BMI decreases the risk of diabetes and hypertension (Ettehad et al., 2018). Healthy weight and low cholesterol levels prevent the occurrence of heart diseases significantly. The patient should abstain from alcohol intake. Alcohol intake increases blood pressure, thus making the patient vulnerable to heart disease. Heart disease is a severe problem, yet it can be prevented if the patients avoid health hazards and adopt a healthy lifestyle. All the above measures can effectively prevent the hospitalizations fro heart diseases.
References:
Amiri, P., Mohammadzadeh-Naziri, K., Abbasi, B., Cheraghi, L., Jalali-Farahani, S., Momenan, A. A., … & Azizi, F. (2019). Smoking habits and incidence of cardiovascular diseases in men and women: findings of a 12 year follow up among an urban Eastern-Mediterranean population. BMC public health, 19(1), 1042.
Aune, D., Schlesinger, S., Norat, T., & Riboli, E. (2018). Tobacco smoking and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies. Scientific reports, 8(1), 1-9.
Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., … & De Backer, G. (2011). Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. European heart journal, 32(17), 2143-2152.
Bibbins-Domingo, K. (2016). Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 164(12), 836-845.
Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., … & Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957-967.
Farmakis, D., Parissis, J., Lekakis, J., & Filippatos, G. (2015). Acute heart failure: epidemiology, risk factors, and prevention. Revista Española de Cardiología (English Edition), 68(3), 245-248.
Kachur, S., Lavie, C. J., De Schutter, A., Milani, R. V., & Ventura, H. O. (2017). Obesity and cardiovascular diseases. Minerva medica, 108(3), 212-228.
Lu, L., Mackay, D. F., & Pell, J. P. (2014). Meta-analysis of the association between cigarette smoking and peripheral arterial disease. Heart, 100(5), 414-423.
Melenovsky, V., Hwang, S. J., Lin, G., Redfield, M. M., & Borlaug, B. A. (2014). Right heart dysfunction in heart failure with preserved ejection fraction. European heart journal, 35(48), 3452-3462.
Nordahl, H., Osler, M., Frederiksen, B. L., Andersen, I., Prescott, E., Overvad, K., … & Rod, N. H. (2014). Combined effects of socioeconomic position, smoking, and hypertension on risk of ischemic and hemorrhagic stroke. Stroke, 45(9), 2582-2587.
Patrono, C., Morais, J., Baigent, C., Collet, J. P., Fitzgerald, D., Halvorsen, S., … & Vilahur, G. (2017). Antiplatelet agents for the treatment and prevention of coronary atherothrombosis. Journal of the American College of Cardiology, 70(14), 1760-1776.
Ponikowski, P., Anker, S. D., AlHabib, K. F., Cowie, M. R., Force, T. L., Hu, S., … & Samal, U. C. (2014). Heart failure: preventing disease and death worldwide. ESC heart failure, 1(1), 4-25.
Sievenpiper, J. L., & Lavie, C. J. (2018). Dietary prevention of cardiovascular diseases. Progress in cardiovascular diseases, 61(1), 1-2.
Skilton, M. R., Maple-Brown, L. J., Kapellas, K., Celermajer, D. S., Bartold, M., Brown, A., … & Jamieson, L. M. (2011). The effect of a periodontal intervention on cardiovascular risk markers in Indigenous Australians with periodontal disease: the PerioCardio study. BMC public health, 11(1), 1-8.
Sok Fun Khow, K., Yin Lau, S., Yuanzhi Li, J., & Yean Yong, T. (2014). Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention. Current Drug Safety, 9(1), 2-15.
Taylor, R. S., Ashton, K. E., Moxham, T., Hooper, L., & Ebrahim, S. (2011). Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review). American journal of hypertension, 24(8), 843-853.
Zhao, Y., & Dempsey, K. (2006). Causes of inequality in life expectancy between Indigenous and non‐Indigenous people in the Northern Territory, 1981–2000: a decomposition analysis. Medical Journal of Australia, 184(10), 490-494.
