CARDIOVASCULAR DISEASE Cardiovascular diseases (CVD) have become the greatest threat to Filipinos today.

Man faces the risk of CVD throughout his life. At birth, Congenital Heart Disease and vascular malformation are a possible affliction. In early childhood, the risk of Rheumatic Heart Fever/Rheumatic Heart Disease starts. In early adulthood, asteriosclerotic changes in blood vessels may set in and and the progress to the development of hypertension. During the middle age, Coronary artery Disease or Ischemic Heart Disease develops and leads to Myocardial Infarction in many, particularly in males. Among the elderly, Cerebro-Vascular Accident is a common complication of Hypertension.

Cardiovascular Diseases have varied and multi causes and risk factors, ranging from infectious agents, environmental and constitutional causes, some inherited and some acquired. DISEASES Congenital Heart Disease Rheumatic Fever/Rheumatic Heart Disease Essential Hypertension Coronary Artery Disease(Heart Attack) Cerebrovascular Accident Magnitude of CVD in the Philippines o According to statistics(2010), Cardiovascular Diseases were the 1st leading cause of mortality in Region 8. o Based on the 2006 report of DOH, diseases of the heart were the 1st (rated 95.5) and those of the blood vessels were the 2nd (rated 63.8) leading cause of of mortality in the country. Common Cardiovascular Diseases: Congenital Heart Disease -CHD is by far the most prevalent type of heart diseases. There are many forms of congenital heart diseases. The causes of CHD may be group into: a. Environmental Causes- malformation in the heart and/or blood vessels may result from illness of the mother or her taking some substances or drugs during pregnancy. Maternal German Measles (rubella) is one of the most common causes of CHD. Among the substances which are known to have caused congenital heart anomalies in the offspring of women who have taken them during pregnancy are alcohol and thalidomide. b. Maternal Diseases-some maternal diseases if untreated can cause CHD. DM and PKU are among these. Both diseases are inherited. The first is characterized by deficiency in insulin which is essential in the metabolism of carbohydrates; the second by deficiency of an enzyme which catalyzes the metabolism of phenylalanine. c. Genetic Factors-congenital malformation of the heart are present in a large percentage of children with genetics aberrations such as mongolism, or other forms of Trisomy, CAUSES/RISK FACTORS Maternal Infections, Drug intake, Matrenal Diseases, Genetic Frequent Streptococcal Sore Throat Heredity, High Salt Intake Smoking, Obesity, Hypertension, Stress, Hyperlipidemia, DM, Sedentary Lifestyle Hypertension, Arteriosclerosis

Turners Syndrome, ets. It is important to point out that maternal age-very young and very old primiparas-contributes to these conditions. *CHD may have familial clustering. It is not uncommon to have more than one child in the family with CHD. A greater risk of having CHD has been documented where the father and the mother are blood relatives.

Rheumatic Fever/Rheumatic Heart Disease -RF/RHD is an autoimmune disease, that is, the patient develops antibodies which react to the bodys own antigens in the connective tissues of the heart, as well as in other systems. The antibodies are produced in response to repeated and untreated streptococcal infections, usually of the throat. -It is a late sequel of Acute Rheumatic Fever, occurring years after the acute phase of the disease has taken place. -It is usually a disease of children. The incidence of sore throat in Filipino children is highly particularly among the poor. Important factors that contribute to this include nutritional deficiencies, poor housing and unsanitary conditions and overcrowding. 20-25% of all sore throats are due to infection with streptococcus (group A beta hemolyticus). -There is a familial predilection to rheumatic fever. The siblings of the mother with rheumatic fever have a greater risk of getting the disease than individuals in the general population.

Ischemic Heart Disease -Ischemic Heart Disease is usually caused by the occlusion of the coronary arteries by thrombus (clot) formation of areas of narrowing and hardening (arteriosclerosis) in these arteries. The supply of oxygen in the coronary arterial becomes inadequate to provide for the oxygen demands of the heart when the arteries are obstructed or constricted. The lack of blood supply causes necrosis or death of the affected tissues (myocardial infarction or heart attack). -The occurrence of the disease increases as one grows older and is higher among the males than females because the females are afforded some protection by the female hormone estrogen before menopause. Major Factors: Hypertension The incidence of coronary artery disease is three times the normal in people. Diabetes Mellitus the incidence of CAD is greater in patients with diabetes mellitus and occurs 10-12 years earlier. This is probably related to the abnormal lipid metabolism, associated hypertension, obesity and accelerated agent prevalent in patients with diabetes mellitus. Serum Lipid Concentration - The incidence of CAD is directly correlated with increased serum lipid concentrations. Individuals with familial hypercholesterolemia are

subject to premature CAD in the third decade of life. Elevated cholesterol levels are also correlated with an increase incidence of CAD. Cigarette Smoking The incidence of heart attack or myocardial infarction is increased more than 3 times in cigarette smokers. The increased incidence of infarction appears related to changes in coagulation, myocardial irritability and possibly coronary artery spasm. Minor Risk Factor: Stress is a complicated risk factor and is probably related to lifestyle, including physical activity, dietary habits, smoking, etc. then to CAD. A strong Family History is important. The incidence of CAD is more than double of two or more family members have a history of CAD. Heredity partly determines cholesterol levels. Obesity. Obese patients have a markedly increased incidence (3-4 times) of CAD. It is suggested that the increased workload demanded of the heart where obesity maybe a significant factor. Sex. The incidence of CAD in women before 60 years of ages is far less than in men in the same age. After menopause, the incidence of CAD in women increases yearly until it equals that in men. This and other evidence suggests that estrogens retard the development of CAD. Prevention of CVD occurrence. The promotion of health through the prevention of development of exposure to CVD risk factors is referred to as primordial prevention. Specific protection from CVD is also achieved by the removal of the risk factors or reduction in their levels.

Disease Congenital Heart Disease

Primordial Prevention of viral infection and intake of harmful drugs during pregnancy. Avoidance of marriage between blood relatives. a. Prevention of recurrent sore throat through: Adequate environmental sanitation Avoidance of overcrowding Adequate treatment of sore throat. From early childhood: Low salt diet Adequate physical exercise. Prevention of

Specific Protection Adequate treatment of viral infection during pregnancy. Genetic counseling of blood related married couples. Identification of cases of rheumatic fever. Prophylaxis with penicillin or erythrocin.

Rheumatic Heart Disease

b. Essential Hypertension a. b.

Continued low salt diet and adequate exercise.

Coronary Artery

Cessation of smoking

Disease(Heart Attack)

development/acquisitio n of risk factors: a. Cigarette smoking b. High fat intake c. High salt intake Adequate exercise.

Cerebro-Vascular Accident(Stroke)

all measures to prevent hypertension and arteriosclerosis

Control/Treatment of diabetes, hypertension Weight reduction Change to proper diet Adjustment of activities: a. Relaxation b. Exercise all measures to control hypertension and progression arteriosclerosis.

FUNCTION OF COMMUNITY HEALTH NURSE IN THE PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASE Health education to clients families and to vulnerable groups on the following: Maintenance of Ideal Body weight

Weight control is useful for preventing and correcting high blood pressures and diabetes. The goal of body weight should be within 15% of desirable weight. The patient should be initiated on a dietary program coupled with exercise. Diet and Modification of dietary fats

Dietary education must be initiated. Dietary changes recommended for obese individuals with or without hypertension. Smoking/tobacco Avoidance

Complete cessation of cigarette smoking should be advised to all individuals, whether he/she is hypertensive or not, and particularly those with special risk of coronary heart disease (CHD). Nicotine increases/activates blood pressure activity. Exercise

Regular exercise programs such as walking, bicycle, jogging, etc., facilitates weight control and increase cardiopulmonary stamina. These activities are helpful in reducing blood pressure but shall only be done after clinic evaluation of a cardiovascular client.