Impact of Coronary Heart Disease on Old People

This research focuses on analyzing the impact of coronary heart disease among old people. It discusses the causes, risks, and impact of coronary heart disease on their health. It also explores the role of care professionals in promoting healthy habits and strategies for treatment.

Cardiovascular Disease

Table of Contents
Abstract............................................................................................................................................1
Introduction......................................................................................................................................1
Aim of the research................................................................................................................2
Research objectives................................................................................................................2
Research questions.................................................................................................................2
Main Text.........................................................................................................................................2
The basic understanding about coronary heart disease..........................................................2
The causes behind occurrence of coronary heart disease among old people.........................5
The risk of occurring several types of other diseases due to presence of coronary heart disease
................................................................................................................................................7
The impact of coronary heart disease on health of old people...............................................8
The role of care professionals to promote healthy habits among old people to avoid coronary
heart disease............................................................................................................................9
The strategies and practices in order to treat the coronary heart disease among old people11
Conclusion.....................................................................................................................................12
References......................................................................................................................................14

Abstract
In context of this project, it is based on the aim of analysing the impact of coronary heart disease
among of people. It includes the basic knowledge about coronary heart disease which includes
the condition when arteries become narrow which is responsible for limiting blood flow to the
heart, this situation can be considered as severe one which has potential to occur the problem of
heart attack, angina or stroke. It is necessary for people to improve lifestyle by making
appropriate changes, intake balanced diet, avowing junk food, adopt regular exercise & walking
etc. which facilitate to avoid the condition of occurring coronary heart disease between senior
citizens. However, this investigation will focus on several objectives like evaluation of potential
causes behind coronary heart disease and relevant risk of developing other health problems due
to presence of CHD. It includes various causes like high blood pressure, improper lifestyle, habit
of alcohol intake or smoking, drug addiction and many more. It is very important for senior
citizens to take precautions on regular routine in order to improve the health condition of them.
Moreover, it includes the discussion about role of care professionals for making old people
aware of different precautions and various aspects in respect of reducing risk of occurring
coronary heart disease. It consist their responsibility to organise more effective as well as
efficient health promotion campaigns for increasing knowledge level of senior citizens for
enhancing their lifestyle. It will provide support to avoid condition of coronary heart disease
along with remaining healthy.
Introduction
Heart disease refers to a condition including infected vessels, structural issues and blood clots. It
includes the several kinds of heart problems which are commonly observed among old people
such as coronary heart disease, high blood pressure (Hypertension), cardiac arrest, congenital
heart disease, arrhythmia, coronary artery disease and many more (Raygan and et. al., 2018). In
context of this project, it is based on the aim of analysing effects of coronary heart disease
among older people regarding their health condition. This investigation will focus on causes and
relevant risk of coronary heart problems occurs among old people. It will also include impact of
coronary heart disease and role of care professionals to promote healthy habits to avoid the same.
The strategies and practices used for treatment of coronary heart disease are explained here.
1

Aim of the research
“To analyse the impact of coronary heart disease among old people.”
Research objectives
 To identify the basic understanding about coronary heart disease.
 To evaluate the causes behind occurrence of coronary heart disease among old people.
 To determine the risk of occurring several types of other diseases due to presence of
coronary heart disease.
 To examine the impact of coronary heart disease on health of old people.
 To analyse the role of care professionals to promote healthy habits among old people to
avoid coronary heart disease.
 To demonstrate the strategies and practices in order to treat the coronary heart disease
among old people.
Research questions
 How to identify the basic understanding about coronary heart disease?
 What are the causes behind occurrence of coronary heart disease among old people?
 How to determine the risk of occurring several types of other diseases due to presence of
coronary heart disease?
 What are the ways to examine the impact of coronary heart disease on health of old
people?
 How to analyse the role of care professionals to promote healthy habits among old people
to avoid coronary heart disease?
 What are the strategies and practices in order to treat the coronary heart disease among
old people?
Main Text
The basic understanding about coronary heart disease
Coronary heart disease (CHD) can be described as a condition when coronary arteries become
too narrow due to which supply of oxygen and blood to heart was interrupted. According to the
views of Raygan and et. al. (2019), it tends to usually developed due to increased levels of
cholesterols which creates plaques in artery walls that is responsible for narrowing the arteries.
This condition leads to reduce blood flow which is accountable to cause severe health issues
2

among people. It includes the main role of coronary arteries in order to formulate a network of
blood vessels on heart surface that feed it oxygen and narrowed arteries will not provide oxygen
rich blood especially at the time of physical activities (Cruise and et. al., 2019). It is required for
arteries to supply sufficient amount of blood and oxygen to heart which is used for further body
functions respectively. It is observed that narrowed arteries are not able to provide desired
oxygen and blood to the heart which are responsible for developing serious health problems.
Figure 1: Coronary artery disease
(Source: Coronary artery disease, 2016)
However, it has been analysed that coronary heart disease are generally leads to condition of
angina which has several symptoms such as squeezing, pressure, heaviness, tightening, burning
and aching in chest. It also causes several signs including indigestion, heartburn, weakness,
sweating, nausea and cramping (Aune and et. al., 2017). Meanwhile, it is observed that CHD is
responsible for developing a problematic condition in which people feel shortness of breath
which occurs when heart as well as other organs did not get sufficient amount of oxygen. it is
necessary for people to follow healthy lifestyle to maintain appropriate condition of body to
avoid severe disease like heart problems during old age.
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In addition to this, it has been identified that coronary heart disease has potential to develop
complicated condition of heart attack that develops when heart muscles did not get enough blood
or oxygen. It includes the condition when a blood clot generates from plaque in one of the
coronary arteries. Basically, the building up of blood clot can be considered as a condition of
coronary thrombosis which indicates number of symptoms such as mild or crushing chest pain,
coughing, dizziness, shortness of breath, a gray pallor in the face, general discomfort, panic,
vomiting & nausea, sweating, clammy skin and chest discomfort. As per opinion given by
Carney and Freedland (2017), the initial symptom of heart attack is pain which can spread to
neck, jaw, ears, arms and wrists that can possible spread to the shoulder blades, back or abdomen
accordingly. In this case, change in position, resting or lying down is unlikely for bringing relief
and this pain of heart attack is accountable to remain constant or may come and go. Meanwhile,
it has been analysed that heart attack can be considered as severe condition which develops a
medical emergency that may leads to death or permanent heart damage. The coronary heart
disease is generally responsible to cause some of relevant problems like chest pain (chest), heart
attacks and heart failure accordingly (Satoh and et. al., 2020). It is necessary for people to prefer
regular check ups and healthy habits in order to avoid the heart problems to remain wellbeing.
However, the eating of junk food and extra oily or spicy eatable items are responsible for
developing the problems of heart so that these must be avoided.
The coronary heart disease can be considered as severe health condition which generally occurs
among people having extra body weight because fat molecules get deposited in artery walls
which narrowed that leads to limited blood flow and oxygen supply. As mentioned by Cohen and
et. al. (2020), it is necessary for people to intake balanced diet by taking suggestions from
dieticians and doctors in order to maintain appropriate condition of heart and arteries which is
favourable to avoid the relevant disease respectively. It is observed that people should adopt
healthy habits like yoga and physical workout which is favourable for maintain appropriate body
weight and healthy organs that facilitates to avoid disease or infections. However, it includes
several heart problems which can acquire complicated state such as angina, stroke, and high
blood pressure and so on. It is required for old people to take advice from physicians about
proper routine for avoiding heart disease among them (Zhang and et. al., 2016). It will provide
support to increase immune strength among them and improve condition of heart and relevant
vessels to carry out respective function in proper manner.
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The causes behind occurrence of coronary heart disease among old people
The coronary heart disease among people has been generally caused due to injury or damage to
inner layer of coronary artery which causes fatty deposits of plaque in order to formulate at the
site of injury. It includes the specific deposits of cholesterol and other waste products released
from cells which are known as atherosclerosis. Basically, it has been identified that when plaque
was break off or rupture then platelets are accountable to cluster in particular area in respect of
attempting for repairing of blood vessel. Raygan, Ostadmohammadi and Asemi (2019) states that
it consist the fact that habits and lifestyle of an individual is mainly responsible for occurrence of
coronary heart disease and any other health issues of body. It is necessary for old people to focus
on their regular routine work and eating habits in order to avoid the condition of heart problems.
Meanwhile, it has been identified that t is observed that condition of being overweight or obese
are mainly at risk of occurring coronary heart disease. It is required for old age people to adopt
the routine of having morning walk and regular exercise which is beneficial to improve the
stamina of human body to avoid risk of heart disease (Puddu and Menotti, 2018). There are
number of causes behind occurrence of coronary heart disease in which some of them are
explained below.
As per views provided by Schnohr and et. al. (2017), lifestyle can be considered as major cause
behind coronary heart disease because eating habits and regular routine work of an individual is
responsible for developing disease in human body. It includes that improper routine of people to
sleep and wake up in the morning impact negatively on health of an individual which leads to
developing several problems in human body. However, the irregular eating habits by using daily
junk food is responsible for develop bad cholesterol in body and fatty deposition in artery walls
which develop improper supply of blood as well as oxygen to heart that leads to create disease
condition among old age people.
Obesity can be defined as a complicated condition including excessive amount of fat in human
body which develop several problems related to health. It is known to be a severe health issues
because it is responsible for developing risk of occurring several chronic disease like heart
disease, diabetes, high blood pressure and certain kinds of cancers (Lv and et. al., 2016).
However, the obese condition includes when every part of body contains extra fat and these fat
molecules get deposited in artery walls as well which is responsible for developing coronary
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heart disease between old age citizens. It is necessary for people to maintain their body weight
properly to avoid such severe disease.
Unhealthy habits can be considered as wrong activities that become part of life of an individual
but they are harmful for health. It includes several habits like tobacco eating, smoking, alcohol
intake and drug addiction. Meanwhile, it has been analysed that many of citizens has been started
such habits at their young age and become habitual of them due to which they are at high risk of
acquiring severe diseases (Lee and et. al., 2017). The heavy intake of alcohol and smoking are
responsible for occurring problems on functioning of heart which may leads to occurrence of
coronary heart disease accordingly. It is very important for citizens to avoid such harmful habits
and adopt healthy eating to maintain better health condition.
According to Soares-Miranda and et. al. (2016), injury or damage is considered as a condition to
which precautions cannot be taken because it may happen in some accidents of incident that can
happen in anyone’s life. It is necessary for people to avoid travelling in dangerous and risky
places along with remaining careful while dealing with daily life. However, the injury to artery
walls are responsible for developing the condition when amount of oxygen as well as blood has
been supplied in limited amount which is not sufficient for heart to conduct it respective
functions. It will develop the problem of coronary heart disease because the walls of artery get
injured in some accident or incident happened at work place or home. It is required for an
individual to never take physical injuries or pain lightly but immediately get treatment from
doctor for avoiding the same in old age (Kassim, Mohamed and Azim, 2020).
Sedentary behaviour can be defined as way of behaving people to remain sitting or not actively
get up to some physical work. As mentioned by Liu and et. al. (2018), it is observed that people
has such behaviours as they are very lazy on their regular routine and want everything for them
to be done by others. Meanwhile, this kind of sedentary behaviour is responsible for developing
problems related to metabolism which develops the condition of depositing fatty deposits in
artery walls of heart. It will lead to create the problems of coronary heart disease among senor
citizens which becomes severe many times for them. However, it is necessary for individuals to
remain active and start regular work out from the early age which is favourable to improve the
immune strength as well as stamina of body. It will provide support to maintain appropriate
condition of different organs including heart to carry out its respective function in effective
manner (Schnohr and et. al., 2017). Moreover, it is required to remain active and people who
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have sitting job must adopt daily work out to maintain their body figure by avoiding extra body
fat which is helpful to avoid diseases like coronary heart disease respectively.
The risk of occurring several types of other diseases due to presence of coronary heart disease
The coronary heart disease can be considered as a severe health problems related to heart which
is responsible to develop risk of other diseases for an individual. It includes the fact that coronary
heart problem is caused due to number of factors like obese condition, inappropriate lifestyle,
sedentary behaviour etc. Meanwhile, it includes the smoking, alcohol intake and drug addiction
which can cause the CHD among senior citizens (Chair and et. al., 2020). However, it is
observed that if CHD has been not treated on time then it has potential to develop risk of
acquiring several other diseases for an individual. However the old age people were mostly at
risk of such health problems in which some of them are explained here.
Svavarsdóttir, Sigurðardóttir and Steinsbekk (2016) states that high blood pressure can also be
known as a condition of hypertension which occurs when blood pressure become high than
normal. It includes the fact that coronary heart disease has been occurred due to narrowed
arteries which is also a cause for increasing blood pressure of heart. However, the problems of
CHD is responsible for developing the risk of occurring the problem of high blood among old
age which may leads to severe stroke accordingly.
Diabetes can be described as a group of disease in which sugar level of blood increase than
normal levels in human body. As per views of Batty and et. al. (2018), it includes several types
of diabetes like diabetes type 1, diabetes type 2 and gestational diabetes which has their own
causes to be occurred among senior citizens. In context of coronary heart disease, it has been
analysed that CHD has potential in order to increase risk of occurring the type 2 and type 1
diabetes between individuals having old age. However, it is necessary for people to consult from
doctors immediately to gain normal health condition along with avoiding the problem of
diabetes.
Angina is a condition in which several symptoms take place like pressure, heaviness, tightness or
pain in chest which can be sudden or recur over time. It can be considered as health problems
which are generally occurred due to coronary heart disease among old age people. Meanwhile, it
is observed that CHD cause reduce blood flow to heart and its relevant muscles due to which
chest pain or angina has been take place among people. The main reason of angina is reduced
blood flow as well as insufficient supply of oxygen to heart muscles for causing angina due to
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CHD. Heart attack can be defined as a clinical condition which is considered as a medical
emergency. It generally occurs at the time when blood clots are accountable in order to block the
flow of blood to the heart (Sugiyama and et. al., 2019). It develops the situation that relevant
heart tissue didn’t receive blood and loses oxygen, hence, it dies accordingly. However, it has
been analysed that coronary heart disease has condition of damaged artery walls due to which
blood supply and oxygen supply become limited due to which it creates the risk of occurring
heart attack condition among people of old age.
The impact of coronary heart disease on health of old people
According to the opinion given by Wirtz and von Känel (2017), the coronary heart disease is
severe disease which has risk of various other health issues among people. The senior citizens
has slow metabolic rate and recovery due to which their body take more time as compared to
adults to heal with any kind of health problem, infection or wound. Meanwhile, it is observed
that senior citizens has problem of slow recovery arte due to slow metabolism among them so
that they should adopt healthy habits to maintain better health condition. However, the coronary
heart disease impact negatively on health condition of old age people in which important aspects
are explained here.
Less blood flow has been occurred due to narrowed artery or injured artery wall which is
responsible for developing a condition of reduced blood received by heart that impact on health
of an individual. The heart will not able to supply the oxygenated blood in different parts of body
which impact negatively functioning of different part of the body. However, it has been analysed
that reduce blood affects the entire body condition which is problematic for old people in order
to carrying out regular routine to remain comfortable (Smith and et. al., 2018).
The coronary heart disease is responsible for developing the symptoms of causing chest pain in
which a person feel pressure, squeezing and tightening in chest which reduce comfort level of an
individual to conduct regular routine activities. As mentioned by Zullig, Ramos and Bosworth
(2017), it includes the condition of old age to face difficulty to carry out some physical work and
relevant activities then they feel chest pain. However, this health problem of coronary heart
disease is responsible for affecting the health condition of senior citizens by reducing their ease
to work and conduct their respective tasks. Moreover, it will facilitate to develop the weakness in
body and reduced stamina to stay comfortable.
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In context of coronary heart disease, it has been analysed that reduced supply of oxygen is
another negative impact of the problem among old age people which reduces body ability to
carry out routine work in proper manner. Tajabadi-Ebrahimi and et. al. (2017) states that it
includes the fact that decreased supply of oxygen to heart and other body organs are responsible
for interrupting other biological procedures like circulation, digestion, respiration, excretion and
brain function respectively. However, it is necessary for old age people to gain respective
treatment and medication to maintain better health condition of them. The CHD impacts
negatively on independent living of senior citizens which reduces their quality of life
respectively.
The presence of coronary heart disease between senior citizens is responsible for affecting the
health condition with the help of reduced functioning of heart. It includes the limited supply of
oxygen and blood to heart and its muscles as well as tissues that interrupt the respective
functions. However, the improper functioning of heart results into high blood pressure and other
problematic condition for health of old people (Soares-Miranda and et. al., 2016). It has been
analysed that the improper functioning of heart is responsible for developing insufficient supply
of blood and nutrients to human body which impact negatively of health condition of senior
citizens accordingly.
The role of care professionals to promote healthy habits among old people to avoid coronary
heart disease
The care professionals play an important role to make people aware of wrong habits which are
responsible to develop heart disease. According to the views given by Shen and et. al. (2019), it
includes their responsibility to provide knowledge to old people related to precautions to be
taken in terms of avoiding coronary heart disease. It is required to appeal to senior citizen to
strictly follow their diet cart and do regular exercise in order to maintain better health condition.
Meanwhile, it is necessary for medical practitioners to provide appropriate information related to
strategies which are helpful to avoid the condition of coronary heart disease among old people.
They have a role to determine specific health problems like coronary heart disease to provide
knowledge about relevant precaution for wellbeing of people in which some of them are
explained here.
Initially, it is necessary to control the blood pressure because it is responsible for developing the
condition of coronary heart disease among senior citizens. It includes the essential to get blood
9

pressure checked up on regular basis that is at least for once for adults but old people should
remain regular checking for their B.P. Meanwhile, it is necessary for senior citizens to make
changes in lifestyle for preventing and controlling the high blood pressure. Secondly, it has been
analysed that keeping the cholesterol level and triglycerides levels under control as high
cholesterol are responsible for clogging the arteries that raise risk of developing coronary heart
disease and heart attack. As per views of Ghosh and et. al. (2016), the triglycerides are also
known as other type of fats in blood that can create risk of coronary heart disease among senior
citizens due to which they should maintain these components by improving lifestyle. Thirdly, it
is necessary for old people to maintain appropriate body weight according to their height because
overweight and obese condition develops risk of occurring heart diseases. It is required to eat
healthy food by avoiding junk food as well as oily or spicier eatable items to maintain proper
body weight to remain disease free. In addition to this, it is necessary for old age people to
intake balanced diet and prefers healthy food in their daily routine which is light as well as easily
digestible for them (Găman and et. al., 2020). it is required for senior citizen to include plenty of
fresh foods, vegetables and whole grains for maintaining better condition of heart that facilitate
to avoid coronary heart disease. Moreover, the regular exercise and walking can be considered as
effective as well as efficient strategy which provides support to improve health condition to
avoid risk of occurring nay kind of heart disease.
On the other hand, it has been analysed that care professionals has role to carry out different
health promotion campaigns and events for increasing awareness among old people to maintain
their better health condition. As mentioned by Krause, Arah and Kauhanen (2017), it is
favourable to encourage them in order to adopt healthy habits and avoid unhealthy habit which
impact positively on their health respectively. Basically, the care practitioners has responsibility
to provide desired knowledge to senior citizens including to limit alcohol and never drink such
drinks with alcohol which has potential to make people more likely to acquire the coronary heart
disease. It includes the fact that drinking too much alcohol raises blood pressure and adds extra
calories in body which causes weight gain that leads to increase risk of heart disease for senior
citizens. However, it is observed that smoking habit should be avoided by people as it also raises
high blood pressure along with increasing risk of heart attack as well as stroke among them. It is
necessary to manage stress levels by doing meditation because stress is connected to occurrence
of heart disease in many ways. Moreover, it is required for old people to manage their condition
10

by taking proper meals and medicine if they are diabetic as it doubles the risk of diabetic heart
disease. It includes the condition that high blood sugar levels are accountable for damaging
blood vessels which increase the risk of coronary heart disease (Wang and Feng, 2020).
Additionally, it is very important for senior citizens to take proper sleep on regular basis because
condition like insomnia is responsible for developing risk of several heart diseases for them. It is
important for old age people to not intake high oily food and spicy eatable items in respect of
maintain appropriate health status. They should take suggestion from doctors to follow healthy
lifestyle for avoiding heart disease and other health problem to remain disease free.
The strategies and practices in order to treat the coronary heart disease among old people
Coronary heart disease can be considered as a severe health problem occurs between senior
citizens that are required to be treated immediately. According to Hoseini and et. al. (2019), it
includes the condition with narrow arteries and limited blood flow that can cause several
problems and relevant complications. Basically, it has been identified that medical professionals
use various kinds of clinical practices and strategies for treating the problem of coronary heart
disease. It includes number of practices and procedures which can be used or treatment of the
selected disease among old age people in which some of them are given below.
In context of coronary heart disease, it includes the utilisation of effective diagnosing procedures
and strategies to diagnose the CHD condition of an individual. It includes the use of different
clinical procedures such as ECG (electrocardiogram), holter monitor, echocardiogram, stress
tests, coronary catheterisation, CT scans, nuclear ventriculography and blood tests. However, the
desired diagnosing methods are used by doctors in order to evaluate actual condition of patient in
order to formulating an appropriate care plan for their wellbeing. Moreover, it will facilitate to
deliver better quality of treatment ad medications for improving health status of old suffered
people.
It has been analysed that CHD is a kind of problem which has no cure but it can be managed
with the help of several strategies. Peltzer and et. al. (2020) states that it includes the several
aspects to be adopted in lifestyle to make some of changes such as quit smoking, healthy diet and
getting regular exercise. Meanwhile, it involves the use of different types of medications in order
to treat the condition of coronary heart disease. Initially, it includes the use of beta-blockers
which is favourable in terms of reducing blood pressure and heart rate to manage condition of
heart attack. Secondly, it contains nitroglycerin patches, sprays or tablets which are helpful for
11

widen arteries along with decreasing the demand of blood and soothe chest pain respectively.
Thirdly, it consist the use of angiotensin-converting enzyme inhibitor which helps in bringing
down blood pressure as well as facilitate to slow or prevent progression of coronary heart
disease. However, the utilisations of calcium channel blockers that facilitate in widen coronary
arteries in order to enhance flow of blood to the heart as well as decreasing the condition of
hypertension respectively. Meanwhile, the use of statins is suitable for reducing progression of
CHD and reduces risk of relevant deaths among senior citizens in effective manner.
In addition to this, it has been identified that different kinds of surgical methods are used by care
practitioners in terms of treating the health problem of coronary heart disease between senior
citizens. As per opinion of Siow and et. al. (2018), it includes the laser surgery that consists the
way of making several small holes in heart muscles which is favourable in order to encouraging
the formulation of new blood vessels. Meanwhile, it consist the other method of coronary bypass
surgery in which a blood vessel has been used from another part of the body in respect of
creating a graft which bypasses the blocked artery. This graft is responsible to come from leg or
an inner chest wall artery. However, it involves the angioplasty and stent placement which
surgeon will insert a catheter into narrowed part of artery and pass a deflated balloon via the
catheter to the affected area. Moreover, it is observed that medical practitioners encourage old
people to remain physically more active and limit the intake of alcohol by avoiding habit of
smoking. It is necessary to avoid use of tobacco and adoption of diet with less sugar, salt and
saturated fats respectively.
Conclusion
From the above study, it has been concluded that coronary heart disease is known to be severe
health condition which has no cute but it can be managed with the help of several precautions ad
medications. It includes various symptoms such as pressure, heaviness, tightening, burning
squeezing and aching in chest which results into several complicated heath issues like heart
attack, angina as well as stroke. Meanwhile, it is observed that coronary heart disease includes
the condition when artery walls become narrowed which is responsible for limiting the sufficient
flow of blood to the heart that causes diseased condition among senior citizens. It consist number
of cause behind occurrence of CKD including lifestyle, irregular eating habits, obesity, tobacco
eating, smoking, alcohol intake, drug addiction, injury or damage and sedentary behaviour. It is
12

required that old aged people should avoid such habits and elements from regular routine in
order to reduce risk of occurring the problem of CHD respectively.
In addition to this, it has been identified that coronary heart disease is responsible for developing
risk of occurring severely health issues like hypertension, diabetes, stroke, angina and heart
attack which impact negatively on health condition of old age people. It is observed that several
kinds of less blood flow and chest pain which reduce feeling of ease to work on daily routine
easily among senior citizens. It includes the negative effects of CHD including reduced supply of
oxygen along with affecting the health condition with the help of reduced functioning of heart
which impact negatively on entire health condition of individuals. However, the care
professionals has role to increase knowledge level of people with the help of conducting
effective health promotions about precautions like maintaining appropriate levels of blood
pressure, cholesterol and triglycerides to manage CHD. It is observed that several medications
are used like beta blockers, nitroglycerin patches, sprays or tablets, angiotensin-converting
enzyme inhibitor, calcium channel blockers and statins along with several surgical methods
consisting laser surgery, angioplasty and stent placement as well as coronary bypass surgery
accordingly.
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