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Field of study:
Health Sciences
Class:
Projet d'intégration en sciences [H360200SA-01]
Methodologie
Student name:
Andréanne Racine (1450337)
Work presented to
François Lemoine
Winter 2015
Methodology
For my internship, I have decided to go to Bocas Del Toro, Panama with the
organisation Floating Doctors. Outside of Panama City, there are no health services.
Therefore, floating doctors help small township by getting them medical care. I have
chosen to go with this organisation since I like to help othes. I like the fact that the
organisation are helping a population in need by providing them a permanent medical
system. I will follow floating doctors in their work. More precisely, I will study coronary
heart disease as well as its treatments and medication. Before making this study, I will
have to research coronary heart diseases itself, the causes, the symptoms and
diagnosis, the prevention, the medication and the treatments.
More precisely, coronary heart disease is when there is plaque inside the heart artery.
The plaque is called atheroma and it is made of cholesterol and other waste substances
(NHS, 2014). It prohibits the oxygen from getting to the heart since those arteries are
made to bring the blood to the heart, which contains the oxygen (NIH, 2015). Over time,
as the plaque accumulates, the artery can harden or rupture. Moreover, it causes either
a heart attack or angina. In the case of a heart attack, it occurs when the artery is
completely block. The blood can’t reach the heart; therefore the muscle begins to die
(NIH, 2015). When the artery is not completely blocked, there is chest pain called
angina. The pain can also reach the shoulders, arms, neck, jaw or back. Coronary heart
disease can as well lead to heart failure and arrhythmias due to weakness of the heart
(NHI, 2015). Arrhythmia cause problem with the beating of the heart while heart failure is
the inability to bring enough oxygen to the heart.
Atheroma in the heart (NHI, 2014)
Coronary heart disease is caused by an accumulation of atheroma over the years.
Moreover, there are many factors that cause those plaques. First of all, smoking
increases the risk of developing coronary heart disease by 24% (NHS, 2014). In addition
of making your heartbeat faster, the chemicals in the smoke damage the lining of the
arteries since they are toxic, which increases the risks of having atheroma in them.
Cholesterol also increases coronary heart disease. More precisely, low-density
lipoproteins build up in the blood, which gets stuck in the walls of the arteries. However,
high-density lipoproteins reduce the risk of accumulation of atheroma since it clears the
low-density cholesterol from the blood by destroying it (WebMd, 2016). Hypertension is
also one of the factors that increase coronary heart disease. Hypertension causes the
arteries of the heart to clog or weakens which increases the risk of atheroma getting
stuck in the arteries (World heart foundation, 2016). Diabetes is one of the most
important causes of coronary heart disease. Diabetes damages the blood vessels by
making it more at risk from atherosclerosis (World heart foundation, 2016). Moreover,
stress can sometime promote bad habits such as smoking or bad eating. A study also
showed that people living under intensive stress have a reduce blood flow to the heart
and an irrigular heart beat (World heat foundation, 2016). Obesity is another factor that
increases the risk of developing coronary heart disease since it increases cholesterol,
blood pressure and diabetes. Moreover, eating to much breaks the alpha receptors in
the liver which are use to decrease the amount of sugar in the blood. Genetic is as well
a factor in coronary heart disease. Moreover, diabetes, cholesterol and hypertension are
genetics.
Coronary heart disease symptoms are mostly angina. Heart failure cause the breath of
the patient to be shorter. However, sometimes patients do not have any symptoms until
they either have a heart attack, a hearth failure or arthymia (NIH, 2014). Doctors usually
diagnosis coronary heart disease based on the symptoms and the lifestyle of the person.
There is no test that can diagnose this disease. However, many tests can help the
evaluate if the patient has the disease. For example, electrocardiograms are be used to
measure the heart’s electrical activity. It shows signs of heart damage due to coronary
heart disease. On another hand, stress testing makes the heart beat faster to see if
there is abnormal change in the heart rate or blood pressure. Also, echocardiography
creates a moving picture of the hearth in which the area of poor blood flow of the heart
can be see. To verify cholesterol, sugar, proteins and fat level doctors ask for blood
tests. Finally, coronary angiography is a flexible tube that is inserted in the coronary
arteries from which the doctors can evaluate the flow of the blood through the heart.
(NIH, 2014).
American heart association have discovered that to have the less chances of developing
coronary heart disease a person should do the following: do not smoke, drink alcohol
with moderation, do at least 30 minutes of exercises each day, keep a body mass index
below 25 kg/m , eat less than 10% of your energy from saturated fat, eat less than 2% of
2
your energy from trans fat, eat fish at least once a week, eat at least 400g of fruits and
vegetables per day and eat less than 6g of salt per day. (Kromhout, Menotti, Kesteloot,
Sans, 2002).
When a patient is unable to reduce his coronary heart disease by life changing and diet,
doctors can prescribe medication. They prescribe cholesterol-modifying medications to
lower the amount of low-density cholesterol in the blood that deposits in the arteries.
More precisely, they use statins and niacin as cholesterol-modifying medications. Those
molecules inhibit the enzyme HMG-CoA that blocks the pathway for the synthesis of
cholesterol in the liver, which decrease the amount of cholesterol in the blood (Srinivasa
RK, Prasad T, Mohanta GP, Manna PK, 2011).
Cholesterol lowering drug (Cardiac health, 2016)
Also, aspirin can reduce the tendency of the blood to clot. Aspirin inhibits prostaglandins,
which is the molecule that creates clots in the blood (WebMD, 2016). Beta-blockers are
used to slow the heart rate and decrease the blood pressure. It blocks the effect of
adrenaline, which decrease the oxygen demands of the heart (Mayo clinic, 2015). When
a patient suffers from angina, they can take nitro-glycerine by dilating the arteries of the
heart temporarily. Finally, Angiotensin-converting enzyme (ACE) inhibitors and
angiotensin II receptor blockers (ARBs) decreases blood pressure the same way as
beta-blockers.
As a last resort, there are two surgeries that can help treat coronary heart disease,
angioplasty and coronary artery bypass. More precisely, angioplasty is when a long tube
is inserted in the blocked artery. A wire with a stent is then inserted in the tube and the
stent is left in the artery to keep it open. On the other hand, coronary bypass is an open-
heart surgery. The surgeon takes another vessel that is not block an creates a bypass
so that the blood can pass around the blocked artery (Mayo clinic, 2015).
In conclusion, when I will be in Bocas Del Toro, I will observe the lifestyle of the
population to try to see why coronary heart disease is the number one cause of death.
To gather information, I will ask question to the population about their lifestyle. For
example, I will ask them what they eat or if they are stressed. To complete my
observation, I will as well talk to the doctors about what they think is the main cause of
coronary heart disease in Panama. I will also observe their techniques of diagnosis and
treatment of the disease. Once I will gather all of my information, I will create a
photographic book that explains the disease and its treatments based on my observation
in Bocas Del Toro.
References
Cardiac Health. Statins. Statins [Internet]. 2016 [cited 2016 Feb 28]. Available from:
http://www.cardiachealth.org/heart-disease-treatment/heart-diseasemedications/cholesterol-drugs/statins
Kromhout D, Menotti A, Kesteloot H, Sans S. Prevention of Coronary Heart Disease by
Diet and Lifestyle. Prevention of Coronary Heart Disease by Diet and Lifestyle [Internet].
2002 [cited 2016 Feb 28]. Available from:
http://circ.ahajournals.org/content/105/7/893.full
Mayo Clinic. "Coronary Artery Disease." Treatment. 2015. Web. 16 Feb. 2016.
<http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosistreatment/treatment/txc-20165340>.
NHS. Coronary heart disease - Causes . Coronary heart disease [Internet]. 2014 Sep 26
[cited 2016 Feb 21]. Available from: http://www.nhs.uk/conditions/coronary-heartdisease/pages/causes.aspx
NIH. What Is Coronary Heart Disease? - NHLBI, NIH [Internet]. 2015 Oct 23 [cited 2016
Feb 21]. Available from: http://www.nhlbi.nih.gov/health/health-topics/topics/cad
Srinivasa RK, Prasad T, Mohanta GP, Manna PK. An Overview of Statins as
Hypolipidemic Drugs. International Journal of Pharmaceutical Sciences and Drug
Research. 2011 [cited 2016 Feb 28].
WebMD. "Coronary Artery Disease: Causes, Symptoms, Treatments." WebMD. WebMD. Web.
16 Feb. 2016. <http://www.webmd.com/heart-disease/guide/heart-disease-coronary-arterydisease>.
WebMD. Treating Heart Disease with Aspirin Therapy. WebMD [Internet]. 2016 [cited
2016 Feb 28]. Available from: http://www.webmd.com/heart-disease/guide/aspirintherapy
World heart federation. Hypertension. Cardiovascular disease risk factors - [Internet].
2016 [cited 2016 Feb 27]. Available from: http://www.world-heartfederation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/