The term cardiac tamponade is the most undesirable diagnosis to cardiologists and health care providers in general because of the severe and debilitating effects that it has on the patient.
The term means compression of the heart by pericardial effusion, thus, inhibiting the contraction and expansion of the heart, and if pericardiocentesis delays, the circulation of blood is impeded and death is imminent. Pericardiocentesis is the extraction of fluid from the pericardial layer surrounding the heart using a needle (Maisch & Risti, 2011).
Another cardiac event of profound significance is myocardial infarction, which usually occurs due to the occlusion of the left anterior descending artery (anterior inter-ventricular artery), a branch of the left coronary artery that runs on the sternocostal surface of the heart. The sequel is never pretty since the heart muscles undergo ischemia and die if quick intervention is not availed for the patient; coronary angioplasty and coronary bypass are the current treatment for the condition (Taylor, 2004).
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The above conditions result in angina pectoris (pain radiating from the heart in the pectoral region) where the pain is usually referred to the left submandibular region, the tip of the left shoulder and the medial aspect of the left arm. The referred pain in angina pectoris can be explained anatomically by revisiting the innervation of the fibrous and visceral pericardium (Taylor, 2004).
The fibrous and parietal pericardium are innervated by the phrenic nerve which has the root value of C3,C4, and C5, which correspond with the dermatome of the submandibular region (C3) and tip of the shoulder (C4). The T1 nerve receiving impulses from the intercostal brachial nerve explains the referred pain to the medial aspect of the arm. Even the sympathetic innervation to the visceral pericardium is T1, T2, T3, T4, and T5, the T1 component is the culprit. (Faiz, Blackburn & Moffat, 2011).
Cardiac rehabilitation refers to the professional programs for helping patients with a history of adverse cardiac events or those who have recently undergone invasive surgery such as the placement of a coronary artery stent, coronary angioplasty, aortic-coronary bypass using a graft from the internal thoracic artery, placement of a pacemaker, placement of a new valve, or placement of an implantable cardio defibrillator to boost and speed up their recovery. (Kraus & Keteyian, 2007).
The main objective of the cardiac rehabilitation program is to prevent and help in the reduction of future cardiac problems. In the quest of refining the problem, the program includes counseling sessions on giving professional advice on nutrition. Lowering sodium levels and taking vitamin B are recommended for convalescing cardiac failure patients (Kraus & Keteyian, 2007).
The low sodium level is advised because an increased level of sodium in the organism tends to increase fluid retention, which has detrimental effects on a patient who already has a cardiac failure. The fluid retention occurs because renal perfusion is low, resulting in low or no formation of urine (anuria) (Khan, 2005). As a result, the kidney does not manage to counter the water and salt intake, and consequently, this leads to the retention of fluid.
These effects include cardiac bulging – the heart wall is severely stretched, and this increases the distance to be passed by the electrical impulses and highly predisposes to the ventricular fibrillation where the impulses are transmitted non-concomitantly (Khan, 2005). Thus, some group of cardiac muscles will be contracting while the rest are relaxing. Then, when the relaxing muscles contract, the other group relaxes; thus, there is usually no overall contraction of the ventricles or no blood is pumped out of the heart.
The other debilitating effect of fluid retention is pulmonary edema where the fluid percolates into the lungs, and this has adverse effects on the level of oxygenation of blood. Edema for the entire organism can begin as a result.
Smoking is contraindicated for patients with cardiac problems or those who have undergone any invasive heart procedure. One of the lethal components of a cigarette smoke is polyvinylchloride, which has been shown to predispose to the development of spontaneous lethal ventricular fibrillation (Dekker, 1997).
The diet that is usually advised to patients with any form of cardiac problems is mainly: boiled or baked potatoes, soybeans, prunes, flounder/halibut, and any other types of fish and bananas, which provide potassium. Potassium replenishment is important because an acute loss of vascularization to the coronary arteries causes loss of potassium from the myocardium, and it moves into the extracellular matrix where it is hypothesized to cause ventricular fibrillation unless it is removed by the use of diuretics such as furosemide (Thompson et al, 2003).
Magnesium is also strongly recommended for patients with heart problems. Magnesium is required for many intracellular enzymatic reactions in the body. There are many types of food rich in magnesium: spinach, nuts, such as cashews, peanuts, and almonds, wheat germ, tofu, and brown rice. Low level of magnesium is dangerous for a normal and healthy patient and has colossal adverse effects on a patient with cardiac deficiencies; it causes increased irritability of the nervous system, peripheral vasodilation, and cardiac arrhythmias, especially, after acute myocardial infarction (Milani, 2003).
Reduction in the intake of cholesterol is highly advocated because the LDL (low-density lipoproteins) found in saturated fats have high concentrations of cholesterol (Leon et al, 2005). The low-density lipoproteins are taken up by coated pits on the endothelium and become enclaved in the tunica intima or innermost sheath. When the forming plaque enlarges, it breaks through the intima, and this brings it into direct contact with platelets in the flowing blood: platelets adhere to it, and subsequently, a fibrin meshwork is formed, which entraps the red blood cells, thus forming a blood clot. The clot may occlude the vessel or break away; this type of thrombus is known as a coronary embolus (Guyton, 2011).
Exercises are crucial in reducing heart complications and in strengthening the myocardium after an adverse cardiac event.
According to the statistics in the medical literature, the cardiac output is usually higher for a male marathoner during exercise at 30L/min compared with an untrained healthy young man, which is usually at 23 L/min. The heart mass and its chambers have been shown to increase by about 40% in endurance training athletes even though their resting cardiac output (5.5L/min) is the same as that of a healthy person (Findlay et al, 1997).
A large stroke volume at a reduced heart rate achieves the resting cardiac output of a well-trained marathoner. The benefits of exercises for a patient with cardiac problems are numerous. Exercises cause an increase in the strength of the myocardium via the hypertrophy of the myocyte (increase in the size of the cell). Exercises also causes an increase in the peripheral vascularization of the subendocardial and epicardial surfaces, the weight loss, which results from strenuous exercises, causing loss of sodium chloride (sweat contains a large amount of sodium chloride), and also the reduction of cholesterol level, which cause the atherosclerotic plaques leading to acute coronary occlusion culminating in myocardial infarction. (American Association of Cardiovascular & Pulmonary Rehabilitation, 2004).
The advantages of joining the cardiac rehabilitation program are unquestioning. The flexibility of the program allows anyone to join it, especially, busy people with tight schedules. The complex nutritional requirements and prescribed exercises are worth trying out for anyone with a cardiac problem, or whoever wishes to prevent the development of any cardiac disease.
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