Essay On Coronary Heart Disease

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Coronary heart disease

Coronary heart disease (CHD) is a primary cause of death for both men and women in the United States. CHD includes acute myocardial infarction (MI), angina pectoris, atherosclerotic cardiovascular disease, and all forms of chronic ischemic heart disease (Buttarro, 2013). The patient extreme family history, lifestyles practices, and lack of compliance with medical management are indicators that she is in need of health education enforcement and therapy. It is evident that this patient requires medical management of her diseased condition.

G.G experiences angina, a classic symptom of heart disease. G.G has been suffering from Peptic Ulcer Disease (PUD) that can be attributed to chest pain. Apart from genetic factors, there are environmental risk leading to heart disease (de Mutsert, Sun, Willett, Hu & van Dam, 2014). G.G is a smoker as well as an alcoholic, two risk factors leading to heart disease. Both risk factors lead to the elevated level of triglyceride in the body. An intricate analysis of the family history shows that it has a medical history of heart disease (Dasgupta, 2012). At the age of forty-seven, her dad died from myocardial infarction while the mother is diabetic.

G.G laboratory results revealed elevated levels of cholesterol. These levels require continuous management and monitoring. The lipid profile indicates that she has a concentration of total cholesterol amounting to 325mg/dL, a level that indicates that she has hypercholesterolemia. High Density Lipoproteins levels are very low at 40 mg/dL with high levels of LDL at 160 mg/dL. A healthy person should have high levels of HDL and low levels of LDL (Cirino & Ho, 2013). The triglyceride level is above the recommended values with Fasting Blood Sugar at 109mg/dL. The verdict derived from the lipid profile is that G.G is obese. G.G suffers from high blood pressure with the measurement being 147/80. Funduscopic exam reveals that she has a mild arteriolar narrowing a factor explaining her high blood pressure state. She has no lower extremity edema with neither the liver nor spleen being palpable.

High cholesterol levels in the blood for G.G indicates the worsening situation of her medical status (Dasgupta, 2012). Apart from the phylogenetic factors contributing the familial history of myocardial infarction and related medical conditions such as high blood pressure, it is evident that there are other risk factors. G.G smokes a whole pack of cigarettes and drinks two to three vodka martinis on a daily basis. Studies conducted have shown that people who drink and smoke have a higher likelihood of dying from cardiovascular disease than their counterparts (Dasgupta, 2012). Several years ago, she was advised to see a dietician but did not comply. From the lipid profile, it is evident that G.G has poor nutritional choice or misadvised on healthy food (Clair et al., 2013). Obesity remains a risk factor to cardiovascular disease and high blood pressure.

Fat accumulation in the lower abdomen and consequent clogging of the arteries raise the blood pressure. Abdominal fat is a clear manifestation of obesity. With the systolic pressure for G.G being 147, she is at stage 1 of high blood pressure. All these factors contribute heart disease (Cirino & Ho, 2013). With the fasting blood sugar at 109, G.G is pre-diabetic, a condition in which the individual has high blood sugar levels despite lack of medical confirmation of diabetes. G.G was advised to take an exercise program to manage her weight a consideration she ignored (Edmunds & Mayhew, 2013). Sedentary lifestyle is a contributing factor to heart disease and obesity. Lack of physical activity has been blamed to contribute to overweight. As the medical practitioner I would monitor and educate, especially with a family history and current lab results. Both places the patient at a higher risk for the development diabetes.

A close look at her medication shows that she takes Zestril 10 mg po q AM and hydrochlorothiazide 25 mg po q AM. She also uses Tylenol as needed and multivitamin supplementation daily. She has no allergy to any of the above medication. Zestril is an Angiotensin Converting Enzyme inhibitor, an enzyme involved in the synthesis of Angiotensin I. Studies reveal that high levels of potassium in the blood, a condition also known as hyperkalemia contributes to chest pain. Angiotensin I lead to contraction of smooth muscles in the arteries and capillaries (Edmunds & Mayhew, 2013).
Contraction increases the work for the heart to pump blood thus leading to high blood pressure and the risk of cardiac failure. The problem is compounded by deposit of cholesterol in the arteries. Zestril provides the inhibitory effect on the enzyme leading to low levels of angiotensin.

Consequently, the smooth muscle relaxes reducing high blood pressure (Edmunds & Mayhew, 2013). Apart from high blood pressure, the drug is used in the treatment of heart diseases. HCTZ 25 mg interacts with Zestril leading to adverse effects to the user. As a diuretic, the drug leads to reabsorption of potassium in the tubules to the blood increasing their levels. Her chest pain can possibly be related to Hyperkalemia (Edmunds & Mayhew, 2013). I would order labs to monitor closely for clinical management of G.G.
Many patients benefit from multiple drugs to achieve blood pressure control. G.G has a history of non-compliance and I would strongly consider increasing her dosage of Zestril. I think this approach would be more effective as opposed to prescribing additional medication due non-compliance. Considering she is taking the initial recommended dosage, it can be adjusted according to blood pressure response. Zestril dosage ranges from 20 to 40 mg per day administered in a daily dose (Edmunds & Mayhew, 2013). This patient will also require home blood pressure monitoring prior to administration of medication. She should be educated on the side effects, risk, and need of continuous monitoring for an effective outcome. Tylenol is a pain reliever which reduces the efficacy of Zestril just like other NSAIDs.

Appropriate orders

G.G should continue using hydrochlorothiazide 25mg for treating of High Blood pressure. Despite interaction with Zestril leading to hyperkalemia, HCTZ helps in treating edema and G.G has been wheezing bilaterally an indication of fluid overload. Introducing new medication for High blood pressure would be inappropriate since G.G has no allergic reactions towards Zestril. She should continue using Zestril and avoid Tylenol, a drug reducing its efficacy (Edmunds & Mayhew, 2013).

She should visit the cardiologist for regular assessment of her lipid profile and the blood pressure. The follow up should be twice a month. The patient can enroll with the American Heart Association where she can learn heart disease management together with medication education and recommended modifications. The referral will help the patient understand the necessity of seeing a nurse practitioner for follow-up on his condtions. The cardiologist will help the patient understand the manifestations of myocardial infarction and when to seek emergency treatment.

Other appropriate consultations include:

Social worker-provide assistance with other resources that helps in therapy management

Psychiatrist-due to the family history of chronic illness and depression, this will be offer reassurance and necessary support.

The patient had a history of peptic ulcer disease. Follow-up tests should be done to prevent the recurrence of the infection.

A referral to the dietician is appropriate. After seeing the dietitian, she should be able to substitute MVIs with nutritional food such as fruits and vegetables. Furthermore, the dietitian will advise her the right choices of food including food with high density lipoproteins that will help in replacing high levels of cholesterol in the body. Following the recommendation from the dietitian, the G.G should be able to avoid processed food, fast foods and eat appropriate food portions. She should adopt a DASH eating plan where the diet is rich in vegetables, and fruits while at the same time low in dairy fat.
Summary of the appropriate modifications for adoption.

Modification Recommendation
Weight reduction Maintain normal body weight (BMI, 18.5 to 24.9 kg/m2)
Adopt DASH eating plan Consume a diet rich in fruits, vegetables, and low-fat dairyproducts with a reduced content of saturated and total fat.
Dietary sodium reduction Reduce dietary sodium intake to no more than 100 meq/day (2.4 g sodium or 6 g sodium chloride)
Physical activity Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week)
Moderation of alcohol consumption Limit consumption to no more than 2 drinks per day in most men and no more than 1 drink per day in women and lighter-weight persons

Recommended Laboratory Tests

Echocardiography- a medical tests that uses sound waves to create images of the heart. Appropriate since it helps to check heart abnormalities such as heart valve disease
Chest X-ray- appropriate since it will help in ascertaining the root cause of chest pain.

Lipid Profile Tests-helps to monitor the levels of the cholesterol

Troponin tests- ordered in patients who have chest pain to see whether they have heart attack or any other damage to the heart. Helps in evaluation of heart injury and testings the symptoms associated with heart attack.

Recommended Medications

Lisinopril 5mg po daily- used to treat high blood pressure
Lipitor 20 mg po daily- an adjunct that helps in regulating elevated levels of cholesterol while at the same time increase HDL (good Cholesterol) in patients suffering from hypercholesterolemia. Helps in treatment of elevated levels of serum TG levels.

Aspirin 81mg daily

The patients should be placed in an education plan that helps her know the negative effects of smoking and alcohol intake as well as the need of complying with the therapy. In the education plan she should understand why dietary salt restriction is necessary and the benefits accrued from weight loss (Edmunds & Mayhew, 2013).
G.G has to undergo regular lab checks ups for monitoring her medical status such as blood sugar levels (fasting blood sugar), cholesterol and blood pressure.

Cirino, A., & Ho, C. (2013). Genetic Testing for Inherited Heart Disease. Circulation, 128(1), 4--8.
Clair, C., Rigotti, N., Porneala, B., Fox, C., D’Agostino, R., Pencina, M., & Meigs, J. (2013). Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes. JAMA, 309(10), 1014. doi:10.1001/jama.2013.1644
Dasgupta, A. (2012). The Science of Drinking: How Alcohol Affects Your Body and Mind (1st ed.). Lanham, Md.: Rowman & Littlefield Publishers.
de Mutsert, R., Sun, Q., Willett, W., Hu, F., & van Dam, R. (2014). Overweight in Early Adulthood, Adult Weight Change, and Risk of Type 2 Diabetes, Cardiovascular Diseases, and Certain Cancers in Men: a Cohort Study. American Journal Of Epidemiology, 179(11), 1353--1365.
Edmunds, M., & Mayhew, M. (2013). Pharmacology for the primary care provider (4th ed.). St. Louis, Mo.: Elsevier-Mosby.
Riba, M., Wulsin, L., & Rubenfire, M. (2012). Psychiatry and heart disease (1st ed.). Chichester, West Sussex, UK: Wiley-Blackwell.