Overview and Personal Perspective
on
Cardiopulmonary Diseases

Randie Asuscion, Jonathan Cu, Rommell DeMesa, Gilbert Balid, Joey Piliapil
BCCM Year Level II

Dr. Violeta Abear and Dr. Reynaldo O. Joson
Facilitators

Legazpi City, Albay, Philippines

I. Concept of Cardiopulmonary Diseases

Cardiopulmonary diseases are disorders that affects the normal functions of the heart and lungs that could disturb the complete physical, mental and social well being of individual.

Picture a person affected by cardiopulmonary disease. He will be brought to hospital and it could cause a financial burden to the family. First the bills in the hospital is one problem, secondly when there's no job means no income.

Cardiopulmonary disease victims and family members become unproductive, due to either physical incapacity or emotional consequence of the condition. During recovery phase there would be a possible disability brought about by the disease that may need rehabilitation or continuos medical attention. Some of the family members need to leave their works in order to nurse the cardiopulmonary disease victim. An additional expense on medication and surgery is also a burden on the part of the family.

Man faces risk of cardiovascular disease throughout his life. For example, at birth there is the possibility of congenital heart and vascular malformation. In early childhood there is a risk of rheumatic heart fever, that if not prevented from its subsequent recurrence will eventually lead to rheumatic heart disease. In early adulthood there are arteriosclerotic changes in blood vessels, progressing as the individual grows older, until hypertension takes place. In middle age coronary arterial disease or ischemic heart disease develops, which may lead to myocardial infarction particularly in men.

II. Common Causes of Cardiopulmonary Disease

Research studies have greatly improved our understanding of heart disorders and underlying disease processes and knowledge of risk factors. The three most important risk factors are:

• SMOKING- especially inhaling cigarette smoke
• HIGH BLOOD PRESSURE
• HIGH BLOOD CHOLESTEROL

Other risk factors are less well established such as:

• Lack of exercise
• Obesity
• Senile lifestyle
• Family history
• Other disease such as infection and diabetes

Hardening of the arteries, or atherosclerosis, is when the inner walls of the arteries become narrower due to build up of plaque. Blood clots form so less blood can get through. This can cause heart attack and strokes. High blood pressure, also called hypertension, means the pressure in your arteries is consistently above the normal range. High BP is consistently elevated pressure of 140 mm Hg systolic or higher and/or 90 mm Hg diastolic or higher.

Heart attacks occur when the blood flow to the part of the heart is blocked, often by a blood clot. Heart failure means that the heart is not pumping as well as it should. It keeps working but the body doesn't get all the blood and oxygen it needs.

Diseases of the lungs have diverse causes but share certain clinical features. Limitation of airflow is characteristic and results from bronchial smooth muscle contraction, intraluminal airway obstruction, thickening of airway walls, or loss of distending support by interstitial tissues necessary to maintain airway patency. Hypersecretion of mucus, airway irritability and gas exchange abnormalities result in cough, sputum production, wheezing, and dyspnea

In this day, the most common and most important environmental agents that cause pulmonary disorder are cigarette smoking and air pollution, which is why chronic bronchitis and emphysema become rampant.

Virus and bacteria can cause acute respiratory infection, especially among children, and may predispose the patient to chronic obstructive pulmonary disease in adulthood. Genetic Alpha-1 Antitrypsin deficiency is a well-recognized genetic factor predisposing the patient to emphysema. Other causes are emboli, allergens, occupational, and chemical inhalants.

III. Common types of Cardiopulmonary Disease

The four most common types of cardiovascular disease are:

• High blood pressure
• Coronary heart disease (which includes heart attack and angina pectoris or chest pain)
• Stroke
• Rheumatic fever/rheumatic heart disease

Other forms includes

• Arrhythmias (disorder of heart rhythm)
• Disease of the arterioles and capillaries (including atherosclerosis and Kawasaki disease.)
• Bacterial endocarditis
• Cardiomyopathy
• Congenital cardiovascular defects; congestive heart failure; valvular heart disease; disease of pulmonary circulation and other disease of the circulatory system.

There are several types of lung disorders and the common types are as follows:

• COPD: Chronic Obstructive Pulmonary Disease, a disease state characterized by the presence of airflow obstruction due to its component emphysema and chronic bronchitis and peripheral airway disease.
• Asthma: Reversible airway obstruction characterized by hyperirritability and inflammation of airway.
• Chronic Restrictive Pulmonary Disease: A group of pulmonary disorder with varied etiologies characterized by difficulty in expanding the lungs leading to reduce lung volumes. Pulmonary tuberculosis, caused by Mycobacterium Tuberculosis, presents clinically with fatigue, loss of weight, anorexia, low-grade fever, night sweats, and cough. The cough is dry and later becomes productive of purulent, sometimes bloody discharge.
• Pneumonia: Inflammation of the Lungs with exudation and consolidation.
• Acute respiratory failure: Defined as hypoxia with or without associated hypoxia.
• Cor Pulmonale: A disease of the right ventricle that results from pulmonary hypertension secondary to pulmonary disease, characterized by right ventricular hypertrophy and eventually failure.

IV. Magnitude of Cardiopulmonary Disease

GLOBAL

As of 1998 World Health Organization report, circulatory disease such as ischemic heart disease and cerebrovascular disease are among the world top ranking and most feared diseases, and kill more people that account for 7,375,000 and 5,106,000 deaths or 13.7% and 9.5% respectively for both sexes. Whereas, acute respiratory infection ranks third as a leading cause of death worldwide and has a total 3,452,000 victims and almost 6.4% of the total population.

Acute respiratory infection was the primary leading cause of morbidity worldwide that accounts for 6% of the total population and affects 80,564,000. Ischemic heart disease is the 6th ranking leading cause of morbidity and has the total number of 51,948,000 and affects 3.8%. Cerebrovascular disease is in the 7th ranking, and accounts for 41,626,000 and 3% of the total population for both sexes.

SOUTHEAST ASIA

According to world health organization, Ischemic heart disease is the top leading cause of death in South East Asian countries and has struck 13.8% of the total population. Acute respiratory infection is the second leading cause of death and has 14.3% affectation of the total population. Cerebrovascular disease was the fourth and affects 6.5% of the population. Tuberculosis affects 5.1% and ranks sixth of the total population.

Acute respiratory infection was the number one leading cause of morbidity within the Asian countries and involved 8.1% of the total population. Ischemic hearth disease ranks fifth and includes 3.8% of the total population. Ranking 13 is the cerebrovascular disease and affects 2.1% of the total population for both sexes respectively.

For the past few years cerebrovascular diseases were thought to affect exclusively industrialized nations since they were regarded as lifestyle disease, but now as developing countries modernize, the risk of cerebrovascular, heart, and pulmonary disease are also increasing, partly because of adaptation of lifestyle similar to those common industrialized countries.

NATIONAL

As a developing country, disease of the heart and disease of the vascular system has become the modern epidemics. They are the most escalating disease problem of the Philippines. Disease of the heart is the common cause of mortality in this country (last statistics available-1994) with a rate of 73.3/100,000 population and accounts for 15.7% with total number of 50,307 victims. Pneumonias at 8.8%, ranks third, and affects 28,132 of total population in both sexes. Tuberculosis ranks fifth 8.5% and 27,292 number of victims. COPD was the seventh with the number 11,405, rate 16.6 and 3.5% of total death.

According to Department of health, as of 1994 data, many Filipinos, young and old suffer from different kind of cardiopulmonary disease. This tremendous data threatens and affects national economic stability and the DOH is now requiring attending physicians, hospitals and clinics to submit reports to be able to generate morbidity and mortality rates.

LOCAL (REGION V - BICOL REGION)

According to latest data from DOH. In Region V, cardiopulmonary disease ranks in the top four among leading cause of mortality per 100,000 population on 1998. Respiratory disease is the leading cause of mortality and morbidity in the region and affects 3,995 with the rate of 87.28 per 100,000 population. Common cerebrovascular included were hypertensive diseases, 3,966 in number, with rate of 64.8 per 100,000 and diseases of the heart at 2,374 with a rate of 64,80.

Acute respiratory infection was the leading cause of morbidity in 1998 with total numbers of 120,437 and rate of 2,631.21 per 100,000 population. Disease of the heart ranks 8 in the top ten leading cause of morbidity with rate of 106.09 and affects 4,856 individual. This lower incidence compared to top rank disease is that the disease of heart is less debilitating compared to acute respiratory infection and can have a less frequent consultation.

Respiratory disease is the leading cause of morbidity and mortality in the region. Infectious process can involve either upper or lower respiratory tract or both. Viruses, bacteria, rickettsia, fungi or protozoa may cause them. The increasing mortality rate from respiratory disease is probably the result of increasing incidence of smoking at early age.

V. Personal perspective on possible solutions to cardiopulmonary disease as health problem

Nowadays there's great variation both in developed and developing countries with regards to the increasing incidence of cardiopulmonary disease. It may be the result of demographic location, social, environmental changes, and industrializing country. There must be an effort to change these trends and factors by proper planning and coordination.

In the field of medicine, the goal of controlling cardiopulmonary disease is to develop and implement methods, interventions and diagnostic modalities that will benefit the people, and a system to evaluate and monitor the effectiveness of these interventions.

It is said that prevention is better than cure. Prevention approaches covers measures that aim to prevent the development of known factors, clinical events, and approaches designed to reduce recurrent events, disability and death. The modification will emphasize on lifestyle approaches and medical management of risk factors, early detection and treatment, or rehabilitation of patients with advanced disease.

Income generating programs will help to provide concession in purchase of medicine especially for underprivileged populations. The will and cooperation of every member of the community will help in the success of these programs and require intensive public information and health education.

Cardiopulmonary disease does not only affect the patient and the family but also the community as a whole. The Department of Health specifies primary prevention and early detection measure. Early detection and prevention can be accomplished by knowing the risk factors.

Promotion and protection of health covers a wide range of action that promote individual healthy lifestyles such as:

• Smoking cessation
• Exercising regularly helps develop cardiopulmonary fitness and possibly to protect yourself against coronary heart disease.
• Everyone should know what is their blood pressure and blood cholesterol levels are and what the result mean.
• Reducing cholesterol intake is specially important if you have any of the other risk factor
• Proper dietary intake and human behavioral changes to manage the risk to human health, and health education through the will and cooperation of the community, with the aid from the Government, non-government organizations and private sector, will lower the mortality and morbidity rates, promote a healthy and productive community, and we will become a strong and powerful nation.

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