Quality of life in patients after acute coronary syndrome in a lifestyle context

Размещено на http://www.allbest.ru/

Quality of life in patients after acute coronary syndrome in a lifestyle context

Sulcova J.

Murgova A.

Introduction

Our lives have always been associated with the heart's activity. Its rhythm, from the very beginning of life, expresses the age, joys, and worries. It often reflects good and bad or pleasant and unpleasant things in life. The heart is the first organ in the body that receives oxygenated blood and supplies the blood to the whole organism. The arteries nourishing the heart curl around its surface and form a kind of wreath. That is why they are called coronary arteries. Healthy (intact) coronary arteries can fully supply the heart muscle with blood even at maximum load. However, the information avoiding narrowing of the coronary arteries in the disease process has not been encoded by biological development in the human body. The most common diseases are atherosclerosis and thrombosis. Nowadays, the narrowing of the coronary artery is one of the most common heart diseases and it is considered an epidemic of the second half of the 20th century. This range of manifestations is called ischaemic heart disease (IHD) and it mainly includes acute coronary syndrome (myocardial infarction and angina pectoris). The coronary arteries cannot be blamed since it is a disease that undoubtedly reflects our way of life. All diseases are characterised by various limitations, not only during the disease itself. Most treated diseases require a permanent lifestyle change. Acute coronary syndrome (ACS) belongs to this group as well. If a person overcomes it, it does not mean that his or her life will be the same as before. In order to prevent a recurrence of this disease, which is more likely to occur with each subsequent infarction, it is necessary to change some bad habits or common habits. Knowledge is a prerequisite for us to understand how to change our lives in order not to leave it prematurely because of our own guilt and lack of knowledge.

heart oxygenated blood

Theoretical background

Cardiovascular disease (CVD) causes approximately one-third of all deaths worldwide. ACS is a major cause of mortality and disability in patients. ACS is based on an acute form of ischaemic heart disease (IHD), which is caused in most cases by coronary atherosclerosis and concomitant thrombosis (1). Atherosclerosis is a systemic disease of the coronary arteries and is considered the leading cause of death and invalidity in the USA. It is estimated that there are 40 million people with ischaemic heart disease worldwide. In Slovakia, they account for 53% of total mortality and are one of the main causes of shorter life expectancy. IHD represents a wide range of pathologies and is divided into chronic IHD and acute coronary syndromes. Acute coronary syndromes represent a spectrum of ischaemic myocardial events and are divided into:

non-ST-elevation myocardial infarction (NSTEMI);

ST-elevation myocardial infarction (STEMI);

sudden cardiac death (2).

All acute coronary syndromes, despite differences in their presentation, have a similar pathophysiological mechanism consisting of atherosclerotic plaque rupture, thrombus formation with the subsequent cessation of coronary flow of different degrees, and reduced oxygen supply to the myocardium. The more coronary arteries narrow, the more resistance is put up to the flowing fluid and so the lower current level is produced by the heart as a pump (3). In the past, atherosclerosis was considered the consequence of the excessive storage of cholesterol in the vascular wall. At present, atherosclerosis is understood as the consequence of the complex interaction of risk factors, with the inflammatory process playing a key role. ACS refers to an acute complication of the atherosclerotic process (2). The most common risk factors of CVD include controllable risk factors - hyperlipidaemia, hypertension, smoking, obesity, stress, lack of physical activity, infections, diabetes mellitus and uncontrollable risk factors - age, men over the age of 45, women over the age of 55 and genetic factors (4). ACS is manifested by common symptoms in the chest - pain, pressure, tightness, and burning, which do not stop even if the person is at rest and lasts longer than 30 minutes. The coronary artery becomes blocked by a blood clot, and a part of the myocardium that has been nourished gradually dies. This process usually lasts for several hours and it might cause complete and irreversible damage to the heart muscle. Therefore, the patient should call for help if the symptoms go on for more than 5 minutes. ACS is a battle against time, every minute counts and is important for a further prognosis of the heart muscle. A priority aspect of treatment in patients with ACS is to open the blocked coronary artery and initiate efforts to minimize the extent of myocardial damage. For practical reasons, it is possible to set time intervals of ACS, namely the time of symptom onset, the time of the call for medical emergency and rescue services by the patient, the time of diagnosis of ACS by ECG and admission to a health care facility for reperfusion therapy through thrombolysis or primary percutaneous coronary intervention (PCI) (2). The interval from the onset of symptoms to reperfusion therapy is called the total ischaemic time.

“ECG - PCI” should be performed within 120 minutes, in patients with extensive anterior ACS it is necessary to apply stricter criteria “ECG - PCI” interval less than 90 minutes. The shorter the time, the better the prognosis of the patient suffering from ACS (2). Nowadays, early management of the Mobile Application STEMI is available to rescue teams but not to the public. The application enables audio and graphical notification of ECG delivery. It continuously updates information for the rescuer as well as the Cardio centre about the distance of the ambulance and the expected arrival. Early treatment is associated with the best results. Myocardial ischemia is often the leading cause of sudden death and, therefore, it is necessary to make the public aware of the typical clinical symptoms associated with ACS and call for help. To shorten the total ischaemic time, delay caused by the patient represents the main problem. Hiding the pain and symptoms of ACS and refusing to call for help can lead to unnecessary disaster. Patients have various reasons for delay in calling for help. They are reluctant to call for help, they believe that the difficulties are of temporary or extracardiac origin, or they are not familiar with them and so they decide to contact a general practitioner (5). An optimal approach should be characterised by the situation when people know the typical manifestations of ACS and call the emergency services as soon as possible. The sooner revascularization is done, the greater the chance that the affected part of the heart muscle will recover. The scar will be smaller, and the heart function will be intact (6).

Urgent invasive diagnosis - coronarography examination luminography, can detect and quantify organic stenoses (7). Modern treatment focuses on the identification and revascularization of the most serious coronary stenoses responsible for the clinical manifestation of ACS - “culprit” stenosis. Nowadays, primary reperfusion therapy can be performed as mechanical arterial patency by percutaneous coronary intervention (primary PCI), or drug fibrinolysis can be applied. Treatment should include intensive preventive measures that can stabilize atheromatous plaques (atheromas) in general and reduce the risk of rupture, recurrence or even sudden death (2). Despite a significant decline in mortality in several European countries in the last decade, one in six men and one in seven women die from ACS. However, the significant reduction in CVD mortality cannot be attributed to a significant improvement in lifestyle, but pharmacological, invasive and surgical treatment options.

celkovy ischemicky cas

Picture. Total ischaemic time (Source: Studencan, 2014)

A patient's quality of life after acute coronary syndrome. The consequences of cardiac muscle involvement depend on their size, the total ischaemic time and the initiation of reperfusion therapy. Moreover, they depend on the overall health of the patient and the age. Small vessel involvement and a part of the cardiac muscle at the optimal ischaemic time heal ad integrum, without consequences. A part of the cardiac muscle dies, but the rest of the muscle works normally. Shortly after a heart attack, the heart function is weaker. It takes one or even two months to recover fully. Massive heart attacks, late arrival for revascularization and treatment are serious problems. Moreover, massive heart attacks can lead to permanent impairment of myocardial performance. The dead part of the muscle heals itself by changing into a scar, but it cannot, however, replace the original tissue (8). The heart is then more sensitive to stress, and the function of pumping blood is often impaired. The blood stagnates in both circulatory systems and extra strain is put on the heart and lungs, what can lead to heart failure. The patient is recommended to go for regular check-ups at the cardiology clinic to be examined whether his health condition is getting better or worse and the response to treatment. All patients with acute coronary syndrome must take blood thinners and other medicines, depending on their health condition, to support the heart function as well as reduce high blood pressure and cholesterol.

Obesity and its effect on acute coronary syndrome. Overweight and obesity are major health problems nowadays. Hypertension, diabetes, and high cholesterol are closely related to obesity. These three factors are very dangerous because they negatively affect heart health. Obesity is among the leading causes of ischaemic heart disease, (IHD), myocardial infarction (5). Rising BMI increases the CVD risk, starting at a BMI of 21 kg/m2. Weight exerts a higher demand on the heart of an obese person in comparison with a person of normal weight. It is, therefore, necessary to treat obesity as soon as possible. Non-pharmacological measures include mainly weight control. Weight loss of as little as 5 kg can reduce blood pressure by approximately 4 mm/Hg.

Elevated cholesterol is the cause of atherosclerosis, ACS. Small LDL particles are extremely dangerous since they deposit on the vessel wall and contribute to the formation of atherosclerotic plaques. LDL cholesterol is “bad” cholesterol and its level should be as low as possible. HDL cholesterol is “good” cholesterol because excess cholesterol is transported by its particles to the liver, where it is further processed. Its level should be as high as possible. Controlling levels of fat in the blood is an integral part of appropriate care for a patient after ACS.

Table 1. Body mass index (kg/m2) (Source: Rodionov, 2016)

Table 2. Recommended levels of fat in the blood in patients after ACS (Source: Spinar, 2007)

Diabetes mellitus is another health problem that affects people with obesity, especially if BMI is over 30. The average life expectancy of patients with diabetes is reduced by a quarter (4). Diabetes mellitus and obesity are closely related; more than 80% of patients with diabetes are overweight, half of them suffer from obesity. It means a 7 to 28 times greater risk of developing diabetes. Central obesity is associated with higher risk factors because fat accumulates mainly in the abdominal area. In addition to the BMI values, it is necessary to know the waist circumference. It should not exceed 102 cm for men and 88 cm for women.

Lifestyle changes in connection with diet changes. When reducing weight, it is important to eat properly, it is not enough to cook tasty. Food is our daily companion, and improper eating habits can lead to many diseases. Weight loss also reduces the risk of coronary heart disease, diabetes mellitus, and hypertension. To lose weight, it is not recommended to be on a diet, but to change eating habits individually. Everyone should do the following:

Healthy eating is associated with fresh food. Consume cooked food immediately and do not store food in the fridge or heat it after a few days.

It is important to eat everything that grows on trees or under the ground. Honey, eggs, herbal decoction, dried and fresh fruit with added honey and green tea should be incorporated into a diet plan.

Excess fat in food:

retains radioactive elements,

requires a large loss of energy for digestion from the body itself. It can cause deformation of the digestive tract (liver, stomach or duodenum),

deep-frying food can produce carcinogens,

excess fat clogs blood vessels what leads to heart attacks and strokes (a blood vessel looks like a frying pan covered with a layer of frying oil, and a lot of force is needed to clean it). Fat-containing products can be consumed by people who spend most of their time in the fresh air and do hard physical work (9).

Only eat when you are hungry. Feelings of hunger can be often mistaken for appetite signals. When you feel hungry, you should drink water with honey, lemon juice or tea and hunger will disappear. This way the feeling of hunger is “tested”. The hunger will appear after a while only when the stomach is empty. If the stomach is starving, it slowly returns to its capacity of about 350 cm3.

The food should be healthy, tasty, and simple.

Excess fat also results in a pathetic look of a person, because the muscles are overgrown with folds. If a person is obese and lazy, it can lead to heart diseases.

The popular high-fat cuisine has contributed to the poor state of health of the society for the last 30 years, so it is necessary to change eating habits as soon as possible.

Those who find it difficult to say goodbye to a large amount of food can eat whatever they want, but folds on their abdomen should not exceed 1-2 cm (9).

Eating habits can be changed easily. Eating in moderation does not kill the person, one dies of overeating.

Gradual transition to a healthier diet.

Stage 1

The transition to a different diet should be gradual. We start with vegetable juices (one glass twice a day) and do not change the current diet (for 1-1.5 months). We gradually add more salads and vegetables to the menu so that 30-40% of the daily diet would consist of raw food, cooked or stewed vegetables. The ratio between raw and cooked food should be 60% of raw food and 40% of cooked food. When planning the daily menu, a simple rule should be followed: we eat what grows on the ground, underground, on trees, eggs, honey, sour dairy products. We also drink herbal teas, eat a lot of vegetables, fruits, and drink juices (8).

Stage 2

The order of food consumed: drink fluids 20 minutes before meals and eat fruits before meals.

If it is possible, try to avoid food bad for your health: (black tea, coffee, smoked meat products, desserts, sweets or fried foods).

Let your body get into a raw food diet gradually: consume 50% of raw vegetables, 50% of cooked or roasted vegetables, drink a glass of freshly prepared vegetable juices daily.

Each dish should contain stewed or raw vegetables.

Consume fruits according to the season during the day: only apples, grapes, melons or strawberries. In summer and autumn, eat nothing but strawberries or melons or cherries the whole day.

For breakfast, eat fruits and vegetables and drink fruit and vegetable juices; for dinner, eat salads, cottage cheese, fish, eggs, and before going to bed, drink a glass of kefir.

If possible, exclude semi-finished and canned products from the menu.

Salt restriction - salt causes water retention in the body, so people with cardiac problems should avoid salted foods. Reduced table salt intake leads to a considerable reduction of slightly elevated blood pressure. People, who add salt to a dish as soon as they sit down at the table, are likely to have typical hypertensive behaviour. In case this way of eating is not stopped, it will lead to hypertension (9).

Cut down on sugar - sugar negatively affects the heart function. It can damage and block blood vessels, develop hypertension, and cause recurrence of heart attacks as fats. Triglycerides are to blame. People who eat more sugar than it is recommended per day, are more likely to have a twice higher risk of recurrent heart attacks. People who have suffered a MI should be very careful about sugar intake because their blood vessels are mostly damaged, and excessive sugar intake could make this condition worse (4). Too much sugar in food, sweetened drinks, and sweets should be avoided. A can of a sugary drink contains 30 to 40 grams of sugar (5 teaspoons of sugar).

Drinking regime - fluid intake should be small amounts frequently. A person is made up mostly of water and the whole life is dependent on the constant intake of fluids. Fluids dilute the blood and thus prevent the risk for blood clotting; if a drinking water regimen is not followed, there is a risk of a recurrent heart attack (9).

When losing weight, physical activity is very important. The calories we consume must be burned, and so the movement is crucial after suffering any cardiovascular disease.

Physical activity after acute coronary syndrome. Medical and rehabilitation care is recommended for all patients after ACS. There they are monitored by various professionals, including physiotherapists. Sport, exercise, and physical activity can enhance health. They prevent the development of obesity as well as hypertension and reduce the amount of fat in obese patients. For patients after ACS, dynamic exercise is recommended, where the rhythmic contraction of muscle groups alternates with their release. Such exercises include walking, running, swimming, horseback riding, or crosscountry skiing and they do not require holding the breath too much. Strength exercises, where the individual muscles contract against resistance when holding the breath, are not suitable (10). These include strengthening exercises, bodybuilding, carrying, and lifting heavy objects or construction work. Team sports, such as volleyball, tennis, and football are appropriate diversification of endurance training.

The best form of physical exercise, after being released from the hospital, is a walk. The distance can be gradually extended, running short is allowed. Cycling can be the next activity. It is important to warm up before each exercise because excessive overloading of stiff muscles can lead to a variety of muscle and joint injuries. Exercise should be performed regularly, at least 3 times a week, depending on the patient's general health. It is recommended to drive a motor vehicle on the 7th day after discharge from the hospital, in complicated patients (after cardiopulmonary resuscitation, hypotension or severe arrhythmias) it is recommended to postpone the driving for 2-3 weeks. Flighting by plane in the first two weeks is suitable only for stabilized patients, without dyspnoea, psychological alteration due to excessive fear of air transport. Plane cabins have an air pressure that is equivalent to the outside air pressure at 2,200-2,400 m, so reduced oxygen pressure can cause hypoxia in patients. Patients after ACS are often concerned about the quality of their life, which is also associated with sexual ability and performance. Fear of sexual failure and complications create anxiety and tension, leading to a loss of self-confidence and depression. Sexual activity as a natural part of life has a relaxing effect and poses very little risk in terms of mental and physical strain. It can be restored after 7-10 days. ACS should be an adequate reason for changing the way of life, which also includes relaxation. The path to material pleasures and career is paved with the risks that can be compared to the coronary artery with an atherosclerotic plaque.

Smoking and its effect on acute coronary syndrome. Smoking is a significant influential risk factor that contributes to several cardiovascular diseases. The most common diseases are ischaemic heart disease and strokes. Smoking affects the onset and course of atherosclerosis. Nicotine activates the sympathetic nervous system, acts on the vascular system and causes an increase in systolic blood pressure and heart rate. After smoking one cigarette, the blood pressure rises by up to 20 mmHg and remains elevated for another 30 minutes. Smoking damages the endothelium and causes a higher adherence of platelets, which life span is decreasing. At the same time, the process of blood clotting is accelerating, and the blood viscosity is increasing as well.

Carbon monoxide enters the blood from the cigarette smoke. There it reduces the amount of oxygen carried to the heart and other body organs. Cigarette smoking significantly increases the risk of CVD. It also increases cardiovascular risk and the risk of death when combined with hypertension. Smoking cessation should be an essential part of treating hypertension. IHD is characterized by a disorder of heart function caused by myocardial hypoxia due to changes in the coronary arteries. Smoking increases the consumption of oxygen by the myocardium and influences the narrowing of the coronary arteries, which can worsen the symptoms of coronary heart disease. Increased levels of carboxyhaemoglobin cause a lack of oxygen in the blood, heart rate is increased by nicotine, and thus the consumption of oxygen in the heart muscle - myocardium is increased. Smokers with angina pectoris develop chest pain faster during exercises than non-smokers with the same disability (12). Smoking also increases the risk of developing IHD, which is two to three times higher in smokers, with the relative risk of dying from a myocardial infarction being the highest in young smokers. Quitting smoking means a reduction in the risk of developing IHD by up to 50% in one year, in advanced disease a reduction in mortality by up to 30%. When quitting smoking, it is necessary to motivate patients, to warn them about the possible problems and to advise them to set a quit smoking date. In most cases, patients need help in quitting smoking, so not only further professional consultation is needed, but also motivation from the patients themselves.

Stress and acute coronary syndrome. Both acute and chronic stress contributes to the pathogenesis of atherosclerosis and IHD, so the influence of psychosocial factors is a prevention challenge. Stress factors act at various degrees and are very diverse. Adrenaline is released during the body's stress response causing high blood pressure, heart rate, blood sugar, and fats (13). In the past, the organism used to prepare for the “fight-or- flight” stress response. Nowadays, if a person does not have the opportunity to burn the energy released by stress, then stress has an adverse effect, especially on CVD. Diseases related to ACS are associated with stress. The patient is excluded from normal life suddenly, temporarily but sometimes permanently, and must change his life and work plans. He is often in social isolation and he feels useless. And so, the patient's family is very important in the process of quitting smoking. The members of the family should not only support a healthy diet or weight reduction, but they should also provide psychosocial support to overcome social isolation. Stressful circumstances can often be prevented or alleviated by appropriate hobbies, exercises, relaxation, yoga practice, sleep, and mental hygiene.

Conclusions

Acute coronary syndrome belongs to the diseases that are the result of a combination of several risk factors, which can be uncontrollable or controllable. Everyone takes charge of the factors which can be affected by preventive activities. Most of the risk factors are associated with the so-called modern lifestyle; therefore, ACS is classified as a disease of civilization. Health should be the number one priority for the individual, family, and society. It is also a prerequisite for an active life. Moreover, it affects our daily activities, which we perform either at work as duties or in our personal lives. It is influenced by many factors, such as lifestyle, health, and preventive behaviour of the patient, quality of life, or interpersonal relationships. In health care, health promotion and disease prevention have become important elements, which include efforts to improve overall health. The most important factors in health care are not the financial resources, technical and material equipment of health services, but individuals themselves; their way of thinking, living and willingness to participate effectively in their health care, to show will and perseverance, be intolerant to own laziness, arm themselves with knowledge and seek the way to health because as the old Eastern saying says: “Who does nothing, does not satisfy his own needs”.

References

O'Rourke, R., Walsh, R., Fuster, V. 2010. Kardiologie. Hurstuv manual pro praxi. Praha: Grada Publishing, a. s., 2010, 800 p. ISBN 978-80-247-3175-9.

Studencan, M. 2014. Akutny koronarny syndrom. Bratislava: Media Group, s. r. o., 2014, 240 p. ISBN 978 -80969790-1-1.

Jacobs, A. K., Antman, E. M., Ellrodt, G., Faxon, D. P., Gregory, T., Mensah, G. A., et al. 2006. Recommendation to develop strategies to increase the number of ST-segment-elevation myocardial infarction patients with timely acces to primary percutaneous coronary intervetion. Circulation 2006; 113(17):2152-63.

Sovova, E., Sedlarova, J. 2014. Kardiologia pro odbor osetrovatelstvi. 2. vyd. Praha: Grada Publishing, a. s., 2014, 255 p. ISBN 978-80-247-4823-8.

Fuhrman, J. 2018. Skoncujte s nemocemi srdce. Brno: CPress, 2018, 376 p. ISBN 978-80-264-2060-6.

Kamensky, G. 2011. Aktualne trendy v starostlivosti o pacientov so STEMI na Slovensku. Analyza vysledkov registra Slovaks-2 z roku 2011. Cardiology Letters 2013; 22(2):115-124. (b).

Mitro, P., Valocik, G. 2009. Vysetrovacie metody v kardiologii. Kosice: EQUILIBRIA, s. r. o., 2009, 340 p. ISBN 978-80-89284-26-9.

Danchin, N., Cuzin, E. 2006. Srdecny infarkt, jak mu predchazet a jak se s nim vyrovnaf. Praha: Portal, s. r. o., 2006, 119 p. ISBN 80-7667-077-1.

Tombek, M. 2016. Kniha zdraveho zivota. Cesky Tesin: Beskydy, 2016, 280 p. ISBN 987-80-87431-40-5.

Rodionov, A. 2016. Zdrave srdce. Ako predisf infarktu a mrtvici. Banska Bystrica: TBB, a. s., 2016, 160 p. ISBN 978-80-8111-323-9.

Spinar, J., Vitovec, J. 2007. Jak dobre zit s nemocnym srdcem. Praha: Grada Publishing, a. s., 2007, 256 p. ISBN 978-80-247-1822-4.

Tothova, E., Chloubova, I., Prokesova, R. 2019. Vyznam osetrovatelstvi v preventivni kardiologii. Praha: Grada Publishing, a. s., 2019, 160 p. ISBN 978-80-271-2412-13.

Simon, J. 2001. Epidemiologie a prevence ischemicke choroby srdecni. Praha: Grada Publishing, spol. s r. o., 2001, 264 p. ISBN 80-247-0085-9.

Размещено на Allbest.ru