Studies have shown coronary artery diseases have numerous underlying causes and are grouped as “conventional (major) versus non traditional (novel) and modifiable versus non modifiable” (Huether et al, 2008, p. 622). These risk factors play an important role in the development of coronary heart disease. Some of the non modifiable factors include advanced age, male gender, or women in menopause, heredity and family history of premature acute myocardial infarction(AMI) (George-Gay & Chernecky, 2002).
On the other hand, the modifiable factors include hypertension, dyslipidemia, smoking, diabetes and insulin resistance, obesity, sedentary lifestyle and atherogenic diet (Huether et al, 2008). There are several assumptions or theories that describe some of these modifiable risk factors of coronary heart disease: • Dyslipidemia The development of dyslipidemia is derived from abnormal concentration of lipoprotein in the body. This abnormality results from genetic alterations of lipid metabolising enzymes and target receptors and dietary factors (Huether et al, 2008).
Furthermore, it is believed dyslipidemia contribute to the development of artherosclerosis, and causes systemic disorders such as diabetes mellitus, kidney disease, pancreatitis and hypothyroidism. It is believed that excessive dietary intake of saturated fat/cholesterol contribute to the development of dyslipidenia, thus leading to coronary heart disease (Huether et al, 2008). • Hypertension: To maintain the flow of blood through the capillary walls, arterial pressure must be maintained.
Abnormalities in arterial pressure as in hypertension, causes clinical problems as stated by Martini (2006). Hypertension is defined as the consistent abnormal elevation of blood pressure. This elevation in blood pressure causes increased pressure in the walls of blood vessels throughout the body and eventually results in the damage to the vascular walls. Because of this, the heart increases its workload and this subsequently results in an increase in heart muscle mass thus creating more demand for oxygen that the body needs (Martini, 2006).
Studies show that artherosclerosis cause’s hypertension as it thickens, calcifies and narrows the walls of the arteries in such a manner that it restricts blood flow and causes organ diseases. Furthermore, ABC (2010) reported that medication such as non-steroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, corticosteroids, some antidepressant, hormones (i. e. adrenaline and noradrenaline), can trigger the onset of hypertension making the heart pump harder and causing blood vessels to contract.
In the same fashion, nicotine in cigarettes increases blood pressure, which make the heart work vigorously as carbon dioxide causes the heart to beat faster and takes the place of oxygen in the blood (Better Health, 2010). • Smoking : The heart works best when the supply of oxygen and nutrients in coronary arteries and their branches are met. Studies have shown that nicotine in cigarettes stimulates and increases the release of catecholamine which causes vasoconstriction in the peripheries and increases heart rate (Martini, 2006).
Catecholamine is released by the adrenal glands in response to stress in the body, resulting in high blood pressure and an increased workload of the heart which eventually leads to heart muscle dysfunction (Martini, 2006). According to Better Health (2010), smoking also speeds up the process of narrowing and clogging of coronary arteries and damages other blood vessels leading to infections and gangrene. • Diabetes and insulin resistance: The effect of diabetes and insulin resistance in the body is a very important risk factor of coronary heart disease.
These two risk factors causes and increase the thickening and damage to the vessel walls, inflammation, thrombosis, “glycation of vascular proteins” and decrease production of nitric oxide (vasodilators in the endothelial cells) (Huether et al,2008, p. 624). • Obesity/Sedentary lifestyle: Obesity and a sedentary lifestyle is also a link to coronary heart disease, diabetes, and hypertension (Huether et al, 2008). High cholesterol in the body, results in high accumulation of lipids thus potentiates the risks for coronary heart disease (Gould, 2006).
It is reported that physical activity/exercise decreases the risk of heart disease in children and adults in particular. Decreased inactivity predisposes the person to poor blood circulation and can eventually lead to complications of coronary heart disease (Gould, 2006). In view of Mathew’s case, it is evident (from subjective data presented), genetic factors are one of the main contributing factors to his illness. There is a family history of coronary artery disease, his mother suffers from hypertension and he is also a borderline diabetic; this predisposes him genetically.
As noted above, obesity, smoking, sedentary lifestyles are all risk factors of Mathew’s coronary heart disease. Another problem gathered from Mathew’s subjective data is his emotional and psychological health status. His children are also causing him great mental stress and he probably suffers from depression as a result of the loss of a dear friend from cancer. It is reported that mental stress is link to heart disease. Stress and hypertension influences the heart to work harder and this causes the arteries to constrict due to the increased stimulation of the sympathetic nervous system, thus decreases blood flow to the heart.
This constriction in arteries will eventually destroy the inner lining of the arteries and can lead to serious heart problems such as heart attacks and disturbance in the rhythm of the heart (About. com, 2010). In relation to Mathew’s diagnostic data and physical examinations, it clearly shows the defining characteristics of the manifestations of a heart attack (Funnel et al. , 2006). Risks factors such as diabetes, hypertension, obesity, smoking, family history of coronary artery disease, stress, increased age and gender all contribute to his diagnosis of AMI, a life threatening condition (Virtual Medical Centre, 2010).