Cardiovascular & Abdominal Pain Diseases Essay Examples
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Cardiovascular diseases and Aspirin
Cardiovascular diseases often referred to as C.A.D include myocardial infarction, stroke and peripheral vascular disease can be said to be the foremost reason of death in the U.S and most developed nations. It accounts for almost 900,000 deaths. Aspirin has been discovered to reduce the risks of occlusive vascular events by managing to inhibit the platelet aggregation. However, there exists differences in the way it should be administered and the patients that should get the medication. ADP has also been used in promoting the platelet function and therefore acting as an effective antithrombotic therapy. Glycoproteins are also important when it comes to the antithrombotic therapy and are used to treat coronary diseases.
For more than 100 years now, Aspirin has often been used as a pain reliever. However, since the 1970's this changed and aspiring is now being used to prevent as well as manage heart disease as well as stroke (Sixma, 2009). In fact, there is a recommendation by many doctors that people take baby aspirin for those who are risk of a heart attack (if told by their doctor) and for those persons who have been able to survive a heart attack.
The food and drug administration has come forward and argued that aspirin should be taken by the patients who have a heart disease or even a history of heart attack and stroke (Wolf et al., 2008). The FDA goes further to state that there is a risk of bleeding which sometimes outweighs the benefits of taking aspiring for the people that do not have a history of stroke or heart attack.
Acute coronary syndrome may not be classic and are often intensive; oppressive pressure on the torso that radiates widely to the left arm and abdominal pain might be an acute coronary syndrome. Further, there are other associated symptoms which include chest heaviness, burning, radiation to the neck, arms, and dyspnea. The differential diagnosis for acute coronary syndromes is extremely broad.
Doctors are often advised to treat acute coronary syndromes, this is because it is often best to err when it comes to the sides of caution and treat for an A.C.S (acute coronary syndrome) until other diagnosis. In prior times, PCI that was directly done after fibrinolytic therapy was associated with increased bleeding complications as well as reinfarction. However, this has changed with various improvements in equipment in the antithrombotic therapy (Anderson, 2009).
Cardiovascular emergencies are often life-threatening disorders which must be recognized immediately in order to avoid delay in treatment as well as minimize mortality and morbidity. The patients often have severe hypertension, cardiopulmonary arrest and in some cases chest pains. Although the benefit of aspirin is well-understood in secondary prevention, its net benefit on people without known cardiovascular diseases has not yet been established.
In fact, because of having a lower baseline risk, there is less absolute benefit from aspirin as a primary prevention for the same risk reduction (Sixma, 2009). Further, the adverse effects that are associated with aspirin appear to be completely unrelated to thrombotic risk and consequently have a lower ratio of benefit to risk for aspirin in primary as compared to secondary prevention. Although, the largest effect of aspirin is often the inhibition of thrombosis, other benefits include the increase high-sensitivity protein levels and raising the possibility of having an anti-inflammatory mechanism (Sixma, 2009).
Acute coronary syndromes include unstable angina; this might be a symptom or a change from stable angina. This angina occurs frequently occurs easily at rest, and becomes severe and lasts longer. It is noteworthy to note that although unstable angina might be relieved with oral medications it is often unstable, and it might lead to a heart attack. However, intense medical treatments and procedures are required to treat the unstable angina (Wolf et al., 2008). The Non-ST segment elevation myocardial infarction (NSTEMI) is a type of a heart attack does not cause major changes ECG. However, the chemical markers in the blood often indicate that damage and occurs to the heart muscle. In NSTEMI, , and the blockage may be temporary and partial so that the extent of the damage is minimal.
ST segment elevation myocardial infarction (STEMI)is a certain type of heart attack and is often caused by a the prolonged time of blocked supply. STEMI often affects a large are of the heart muscle, and it causes changes when it comes to ECG and the different blood levels of key chemical markers (Sixma, 2009). Conversely, it is of significance to note that although some people may experience symptoms which indicate that they might soon develop an acute coronary syndrome, and others might not have symptoms until an arrest or pulmonary disease comes. Others have no symptoms of an acute coronary syndrome.
As a part of the diagnosis, there are several tests that are available. A common method is the use of an electrocardiogram often referred to as ECG, EKG, which records heart activity during rest in order to determine abnormal heart rhythms (Wolf et al., 2008). In fact, in some cases, doctors often provide heart monitors that are portable in order to record the electrical activity of the heart in a period of 24 hours. There is also the use of blood tests to measure the circulating levels of cholesterol and fats. The doctor looks at nontraditional risk factors such as the substances homocysteine, the CRP (C-reactive protein), lipoprotein and performs specific tests in order to assess the liver and kidney functions (Wolf et al, 2008).
Lastly, there is the exercise stress tests and is often known as treadmill tests, and it helps determine irregular heart rhythms during exercise. It is during the test that the heart's electrical activity of the patient is monitored through small metal sensors, and it is applied to the skin while one exercises on a treadmill (Sixma, 2009). The Aspirin has several important components, such as ant platelet/anticoagulants, they help prevent the detrimental effects of a hormone angiotensin II that constricts the various blood vessels, which reduce blood pressure and they dilate blood vessels.
The aspirin has propranolol and metoprolol and interferes with nerve receptors in the heart, and it often slows the rise of heart rate and blood pressure in exercise and stress. However, if all treatment fails and the different muscles have been damaged badly, it might require a heart transplant. The survival rate has increased for this surgery and currently stands at around 80 percent and 55% after four years.
Aspirin benefits the heart in several ways. Firstly, it decreases inflammation; inflammation can be described as a component of plaque build-up. It is this inflamed plaque that in many cases is likely to trigger a stroke or heart attack. The Aspirin often fights the inflammation that is associated with the heart disease by effectively blocking the action of an enzyme. In the instances where this enzyme is blocked, the body produces less of prostaglandins, which are chemicals as well as other functions that normally facilitate the inflammatory response (Sixma, 2009).
Aspirin often inhibits blood clots, the prostaglandins in the blood often trigger a series of events which cause blood platelets to clump together in order to from different blood clots (Wolf et al., 2008). Aspirin often inhibits prostaglandins and the formation of blood clots. The blood clots are often extremely harmful because when they clog the arteries supplying the heart muscle and the brain, there is an increased change of heart attack as well as stroke. Aspirin has often been able to reduce the risk of heart attack as well as be able to reduce the short term risk of death amongst the persons suffering from heart attacks (Sixma, 2009). When Aspirin is taken in the course of a heart attack, it greatly reduces the chances of heart damage and consequently increases the chance of survival.
The therapy confers conclusive net benefits in order to offer acute phase of evolving cardiovascular diseases, and it should be routinely administered to virtually every patient with a history of cardiovascular disease. A study of infarct survival more than 17,000 men and women who were suspected to have cardiovascular diseases were assigned with aspirin daily for 30 days. After five weeks, the patients that were allocated to receive aspirin had significant reductions of risk of vascular mortality (23%) nonfatal reinfarction (49%) as well as nonfatal stroke by 46%.
Further, it is of essence to note that an increase in hemorrhagic stroke as well as gastrointestinal bleeding in the patients were not seen and there was a small insignificant increase in bleeding which cannot be directly attributed to the use of aspirin. Therefore, the benefits of aspirin on risk of subsequent MI, stroke, and vascular death are substantial and the risks of serious sensitivity reactions. Therefore, the contradictions to use of aspirin when it comes to acute MI are relative, and they are not absolute.
Risks of Aspirin use
There are risks of aspirin use; evidence shows that the risk of gastrointestinal bleeding with or without aspirin often increases with age. Age and gender are often the most important factors when it comes to gastrointestinal bleeding. Research has shown other risk factors for excessive bleeding often include upper gastrointestinal tract pain, and ulcers (Berger, 2006). Nonsteroidal anti-inflammatory drug therapy which is combined with aspirin quadruples the risk for bleeding compared with the risk that aspirin alone poses.
The rate of bleeding (serious) in aspirin users can be said to be approximately two to three times greater in patients with the history of gastrointestinal ulcer. Research has shown that indeed men have twice the risk for serious bleeding as compared to women, these risk factors often increase the risk of bleeding substantially and should be considered when making the overall decision about the harms and benefits of aspirin therapy. However, the decision in regards to the exact level of risk at which all the potential benefits can be said to outweigh the potential harm that leads to gastrointestinal bleeding (Berger, 2006).
The measure of harm of the major bleeding is the leading side effect that comes with the use of aspirin. Conversely, it is of the quintessence to note that this does not include cerebral hemorrhage. This is mainly because cerebral hemorrhage is often diagnosed incorrectly in some trials. In fact, recent research has shown that cerebral hemorrhage that is caused by aspirin often reduces the benefit from treatment as compared to increasing the harm (Berger, 2006). However, it is of the essence to note that bleeding complications are not reported uniformly in all the different trials. However, the estimate of relative risk for bleeds can be said to be reliable, there is less certainty when it comes the absolute risk of bleeding complications in different control groups in several research.
It was determined that aspirin cannot be prescribed safely when it comes to primary prevention of coronary heart disease without the formal estimation of whether or not the patient has coronary disease (Berger, 2006). In fact, research has shown that the reliance of blood pressure and the use of lipids as a single factor are highly inaccurate and wrong.
The accurate risk estimation often requires the counting as well as weighting the major risks factors for coronary heart disease using risk functions that are derived from epidemiological studies such as Framingham. Therefore, it is important to understand that aspirin treatment for primary prevention should be guided using formal estimation of coronary heart disease risk using the full Framingham equation (Siegel, 2008). Research in regards to primary prevention showed that an aspirin in many cases is likely to do more good than harm.
Many people might be of the thought that avoiding myocardial infarction is of great value as compared to gastrointestinal bleeding. This group of men would in many cases decide to take aspirin in order to lower their chances of contracting a coronary heart disease risk level as compared to men who are afraid of gastrointestinal bleeding (Pignone, 2005). In fact, people who have a high likelihood of benefiting and have little potential for ham should be encouraged to use aspirin. Conversely, it is imperative to ensure that aspirin use is discouraged among men who have little potential of benefiting from the use of aspirin and have a high risk of gastrointestinal bleeding (Berger, 2006).
It is imperative to understand that the evidence on the benefits in men and women who are younger than 45 years old is often limited and the potential benefit of aspirin in this age group is low because the risk of myocardial infarction is extremely low. It has been seen that that the net benefit of aspirin often depends on the initial risks for gastrointestinal bleeding and stroke. The risk factors often include age, diabetes, smoking and history of cardiovascular disease. The excess risk of gastrointestinal bleeding that comes with aspirin, 0.7 per 1000 each year. The relative risk that exists of major gastrointestinal bleeding is 1.4, and this is completely consistent with risks that were observed in other researches.
The optimum dose of aspirin that is used in preventing cardiovascular disease events has not yet been established. However, primary prevention trials have demonstrated the different benefits with various regimens including dosages of 100mg/d, 75mg/d and 325mg/d every other day. Further, the 75mg/d dosage is as effective as the other higher dosages. The risk of bleeding often increases with the dose (Wilson et al. 2005). Although the frequency and optimal timing of discussions that is related to aspirin therapy are currently not known, a reasonable option is that every five years in middle age and cardiovascular risk factors are detected.
The incidence of myocardial infarction and other heart diseases is often very high in older persons and, therefore, the potential benefit of aspirin is extremely large (Wilson et al. 2005). There is an established relationship between increasing age as well as gastrointestinal bleeding; therefore, the potential harms are also large. The benefit of aspirin use in persons who are older than 80 years is probably the best without risk factors for gastrointestinal bleeding.
Clinicians should be able to inform their patients about the adverse consequences that come with gastrointestinal bleeding, and the risks of taking aspirin should be explained to them (Berger, 2006). Using aspirin for the primary disease prevention of cardiovascular disease events often increases the risk for major bleeding events in both genders. In a meta-analysis, it was seen that indeed hemorrhagic strokes were higher in men as compared to women.
The indications for aspirin are divided into three categories. The first is acute treatment, and this is often used during the event, for example, taking a tablet of aspirin when one is experiencing chest pain and probably when one is in a heart attack. The second treatment use is that of primary prevention, the use of aspirin by individuals that are at increased risk of cardiovascular events but have not yet had any cardiovascular event yet (Wilson et al. 2005). This process is often important as it helps decrease the risk. Secondary prevention, on the other hand, is the use of aspirin by persons who have had cardiovascular events to reduce the risk of subsequent events. How aspirin prevents coronary diseases
Platelet adhesion, as well as activation, can be described as a part of a complex process of thrombosis which leads to vascular occlusion as well as subsequent myocardial infarctions and strokes. Therefore, aspirin is often known to be useful when it comes to cardiovascular events because of its unique inhibition of platelet aggregation that is mediated through the permanent inactivation of cyclooxygenases (Wilson et al. 2005). Therefore, blood cannot clot if one has taken aspirin and consequently this helps in greatly reducing the chance of coronary diseases. However, the underlying biological reasons for the differences that exist in terms of epidemiology and aspirin effect are not clearly understood.
Comparison with Adenosine diphosphate antagonist (ADP) and Glycoproteins with Aspirin
Adenosine diphosphate (ADP) often interacts with purinergic receptors on platelets. The initial response to ADP is often to change the shape of the platelet and convert them to a different form (Ridker, 2005). The changing of the platelet into another compound makes the blood not to clot and consequently ensures that blood does not clot in the coronary heart attack to cause a heart attack. There is, however, an important need to make sure that anti-platelet response of an individual patient is measured.
The ADP should be tailored to be given to the individual patients for the optimal effect in order to reduce thrombotic risk. ADP agents have distinct properties in the development and offers additional therapeutic options. In fact, research has shown that ADP often works well with interactions between P2Y12 receptor antagonists and natural agents which eventually contribute to the platelet function. ADP does not have side effects in terms of bleeding as compared to Aspirin. ADP has no known effects on people with gastrointestinal bleeding and it, therefore, has an advantage against Aspirin. However, the effectiveness of ADP depends on the individual as compared to Aspirin that has a high effective rate.
Glycoproteins lla/llb are important as they inhibit platelet activity of the injured coronary plaque and often focuses on the blockage of the platelet facade membrane (Ruf, 2013). The glycoproteins llb/lla binds the circulating fibrinogen, and it crosses links platelets as the common pathway to platelet aggregation. Intravenous agents are often in many cases directed towards this receptor, and it prevents platelet activity. The blockade of the platelet glycoprotein llb/lla receptor often reduces the ischemic complications, and it can be used to manage coronary infections and acute ischemic syndromes (Ruf, 2013). There is a difference in the way glycoproteins lla/llb prevents clotting with that of aspirin.
The glycoproteins lla/llb on initial contact with the platelet glycoprotein often forms a complex that binds itself to the surface preventing platelet adhesion. The fibrinogen receptor GP lla/llb is often particularly important when it comes to platelet-platelet coadhesion. Platelet adhesion and aggregation often induces intracellular signaling in Aspirin and they reinforce platelet activation, vasoconstriction and the slowing of blood flow and it increases vessel wall interactions.
The glycoproteins lla/llb does not any effect on blood flow in the heart and does not lead to bleeding as compared to aspirin. Further, the glycoproteins lla/llb has several side effects especially on men who are above eighty years old. Aspirin use is increasing in the United States and it has been argued that one can be able to use the glycoproteins lla/llb effectively in order to ensure that there is a decreased chance of coronary heart diseases.
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Abdominal pains may be caused by a number of serious underlying illnesses that can be diagnosed and treated. The occurrence of abdominal pains may also be caused by common illnesses such as indigestion, food allergies or even appendicitis (Golan & Tashjian, 2012) .
Test done for the 13 year old female patient may be expected to reflect suspected illness. It would be important to first test for the presence of any infectious agents that may have caused the abdominal pains. The infectious agents may be the rotavirus which is a common virus that affects children to cause symptoms that include abdominal pains (Golan & Tashjian, 2012). Therefore, it would be important not to overlook the possibilities of microbial infection. The suggested treatment for this condition would be use antibiotics and dietary change(Golan & Tashjian, 2012).
Another reason that may cause the abdominal pains may be chronic functional abdominal pain (CFAP). This condition may be present when tests do not show the occurrence of any infection. Functional abdominal pain is caused by a disorder in the transmission of pain impulses. This occurs by action of magnification of the stimulation of the nociceptive impulses from the gastrointestinal tract (Golan & Tashjian, 2012). The cause of this illness may be due to various reasons. Since this condition is not entirely associated with the gastrointestinal tract, it would occur due to a bio psychological disorder (Golan & Tashjian, 2012) . The symptoms of CFAP may also arise due to traumatic life experiences such as sexual abuse or loss of loved ones (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013). It may be due to the fact that emotions may stimulate nociceptive receptors related to the gastrointestinal tract. The treatment for this condition would involve cognitive behavioral therapy which may help in the elimination of thoughts that may trigger the pain. Use of antidepressants is also important as the also act as pain relievers in the abdominal area.
Another cause of the abdominal pain may be the occurrence of dysmenorrhea. It should not be ruled out since the female patient has is old enough to experience menses. Dysmenorrhea is simply painful menstruation (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013). Dysmenorrhea may be caused by production of too many prostaglandins that may cause contraction of the myometrium which in turn may result in pain (Golan & Tashjian, 2012). The most likely dysmenorrhea expected would be primary dysmenorrhea. The management of this condition would involve the use of non-steroidal anti-inflammatory drugs. The drugs include Ibuprofen, Meclofenamate or Naproxen.
Another cause of the abdominal pain may be the occurrence of recurrent abdominal pain which mostly occurs during childhood (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013) . psychological distress may cause abdominal pain symptoms. It can be managed by cognitive behavioral therapy. Recurrent abdominal pain may also be caused by an infection due to presence Helicobacter pylori which can be easily managed by use of antibiotics (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013).
It would also be important to take a pelvic exam because the abdominal pain may be caused by a history of pelvic fracture that may cause stimulation of pain. Urine analysis may also be recommended to test for an occurrence of kidney stones which cause symptoms which include abdominal pain (Golan & Tashjian, 2012). Endoscopy would be recommended when there is suspicion of a problem with organs in the gastrointestinal organs which would be done by a gastroenterologist (Buttarp, Trybulski, Polgar, Sandberg-cook, 2013). If the tests would suggest the occurrence of recurrent abdominal pain it would be important to refer the patient to a pediatrician who would do further tests to ascertain the diagnosis.
Buttarp, M., Trybulski,J., Polgar, B, P., Sandberg-cook, J., (2013). Primary Care. Elsevier Health Science Division ISBN: 9780323075015.
Golan, D. E., & Tashjian, A. H. (2012). Principles of pharmacology: The pathophysiologic basis of drug therapy. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.