Chronic Illness PDF

Clinical Sciences: Medical and Neurological conditions Chronic Illness Tony Wong Assistant Professor of Practice, PolyU Lecture Outline Chronic diseases in Hong Kong Risk Factors of Chronic Diseases Common Chronic Diseases Hypertension Diabetes...

Clinical Sciences: Medical and Neurological conditions Chronic Illness Tony Wong Assistant Professor of Practice, PolyU Lecture Outline Chronic diseases in Hong Kong Risk Factors of Chronic Diseases Common Chronic Diseases Hypertension Diabetes mellitus Kidney disease Heart disease Chronic illness Definition: Chronic disease is a permanent, nonreversible condition that lasts for at least 3 months. (United States National Center for Health Statistics: http://www.cdc.gov/nchs/) Chronic diseases can be defined as diseases that have a prolonged course, that do not resolve spontaneously, and which a complete cure is rarely achieved (Chronic disease epidemiology and control, 2nd Edition) Characteristics : Uncertain etiology Would have their origins at young ages mid age Multiple risk factors > 20-30 years onset: slow progression with many opportunities for prevention Preventable, but generally cannot be prevented by vaccines or cured by medication Can interfere with an individual’s physical, psychological and social functioning with its chronic nature. Requires a long-term and systematic approach to treatment HK figures Statistic from 2020 HK Persons with chronic diseases in HK From 2013 to 2020 1. From 1,375,200 (2013) to 1,799,100 (2020) 2. From 19.2% (2013) to 24.1% (2020) of the total population 3. Living arrangement 95.6 % living in households 4.4% living in institutions Persons with Chronic diseases by age even young children has the possibility to get chronic illness e.g. diabetes Prevalence 1. Hypertension 2. Diabetes 3. Hypercholesterolemia 4. Heart Diseases No. of persons with Chronic diseases in HK The prevalence rate of persons with chronic diseases of total population of Hong Kong was 24.1% in 2020, as against 19.2% in 2013 Main Chronic Diseases and Risk Factors Causes of chronic diseases Common modifiable risk Intermediate risk Main chronic diseases factors factors Unhealthy diet Raised blood pressure Heart disease Physical inactivity Raised blood glucose Stroke Smoking Abnormal blood lipids Diabetes Overweight/Obesity Chronic respiratory diseases Cancer  Healthy Eating Food Pyramid and include the five basic food groups (i.e. grains; fruit; vegetables, meat along with fish, eggs and legumes; milk and milk products) and be active in decreasing fat, salt and sugar intake. WHO recommends a daily intake of at least 400 grams of fruit and vegetables Overweight and obesity Unhealthy diet Inadequate Fruit and vegetable consumption Adequate consumption of fruit and vegetables reduces the risk for cardiovascular diseases, stomach cancer and colorectal cancer Too much Salt intake An important determinant of blood pressure and thus Cardiovascular disease WHO recommendation = 23 (for Asians) Borderline 23 – 24.9 Overweight: BMI 25 – 29.9 Obesity: BMI >= 30 Overweight and obesity is a major risk factor for Cardiovascular diseases (heart disease and stroke) Diabetes (has been strongly associated with insulin resistance) Weight loss can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity. Musculoskeletal disorders (especially osteoarthritis) Cancers (endometrial, breast, and colon) WHO, 2016; Department of Health, 2016 People who are physically active: improve their muscular and cardio-respiratory fitness; improve their bone and functional health; have lower rates of coronary heart disease, high blood pressure, stroke, diabetes, cancer (including colon and breast cancer), and depression; have a lower risk of falling and of hip or vertebral fractures; and are more likely to maintain their weight. Physical inactivity Benefits of physical activity – All age group (>= 17 years or older) Reduce the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer Adults (18 – 64 years old) Reduce risk of depression, hip or vertebral fracture Improve fitness Healthier body mass (BMI 18.5 – 22.9 for Asian) Older adults (65 years old +) Reduce risk of fall, functional and role limitations Better cognitive function Improve bone and functional health WHO recommendation Adults aged 18–64 should do at least 150 – 300 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 – 150 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity. Aerobic activity should be performed in bouts of at least 10 minutes duration. For additional health benefits, should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week. Smoking Creates a lots of health problems Brain Throat Heart Lung Pancreas Intestine and kidneys Baby health Cervical cancer and impotence Smoking prevalence in Hong Kong The Secretary for Food and Health, Professor Sophia Chan, announced (26/05/2022) that the smoking prevalence rate in Hong Kong has dropped continuously from 23.3% in the early 1980s to 9.5% in 2021 HT & smoking smoking cause 2 to 3 times greater risk in death, damage the endothelial lining of the coronary arteries and more plaque formation -> limit blood flow Nicotine cause vasoconstriction of the arteries & and increase heart rate + BP Alter the metabolism of fats: the level of LDL & heart-protective HDL (increase chance of arthrosclerosis) Make the heart more susceptible to lethal ventricular arrthymia & predispose to coronary artery spasm and cause Myocardial Infarction Cause blood to coagulate more quickly & promote thrombus formation flow along the blood vessels to the lungs, heart, brain  What is Blood Pressure? Blood Pressure is the force of the blood pumped against the arteries Blood Pressure changes during the day It can rise with increasing activity level, stress & emotion It is typically lowest during sleep Determinants of Blood Pressure (Arterial Pressure) or AP ** Mean AP = Cardiac Output (Stroke Vol. x Heart Rate) x Total Peripheral Resistance ** 1. Hypertension Major risk factor of chronic diseases (Stroke, heart disease and renal disease…) + could be a chronic condition blood pressure can vary quite a lot during the course of a typical day, depending on your activity level, fluid status, anxiety level……. e.g. salty meal, water intake more blood vessels are contracted Cause: 1. Essential hypertension: no specific underlying cause 2. Secondary hypertension: caused by a specific underlying medical condition, e.g. renal problem, medications, tumors, hormonal imbalance High risk for HT Obesity Often stressed or anxious Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men) Salty diet Family history of high blood pressure Diabetes Smoke African American How to define: Source: American Heart Association In Hong Kong Goal of Medical Management (BP Goals) Moving Targets American Heart Association / ACC: Nov 2017 BP goal heart’s pumping power weaken and impaired ability to supply sufficient blood flow to meet the body's needs (O2 & nutrients) pressure in the heart increases & the chambers of the heart respond by: stretching to hold more blood to pump through the body or becoming more stiff and thickened With time heart muscle walls further weaken kidneys respond by causing the body to retain fluid (water) and sodium If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and termed as congestive heart failure major organs congested & diminished in functions. CHF (Cont’) Symptoms: Multi-organ congestion Lung: shortness of breath SOB (lung is also congested as diminished function of kidney, so water is retained in body). SOB is worse on lying. Persistent dry hacking cough paroxysmal nocturnal dyspnea (wakening in the middle of the night with long-lasting SOB) Bilateral ankle swelling (can be due to prolong immobilization, caution on compression stocking) weak pumping heart rate -> fail to remove the fluid retention Increase in weight of 2-5 lbs or more over several days fatigue Risk factors of CHF Coronary heart disease (pumping action weaken) Hypertension (thicken the wall of heart) Valvular heart disease (overwork the heart) affect blood O2 Pulmonary emboli (pumping action weaken) Severe anemia (oxygen demand by the body tissue beyond the capability of the heart to deliver) Drug side effect: e.g. non-steroid anti-inflammatory drugs (NSAIDS) & diabetic medication (cause Sodium retention) Treatment of CHF Treatment lifestyle changes: such as decreased salt & fluid intake, stop smoking. Medications: Diuretics to reduce overload of heart Beta blockers ABCD ACE inhibitors Treat coronary heart disease: e.g. Valve replacement… In elderly, condition usually worsens with time, overall annual mortality rate of 10% 40% patient die within 4 yrs worsening heart pump power Other terminology in Cardiology Acute Coronary Syndrome (ACS) Patients who attend A&E may experience chest discomfort or shortness of breath -> myocardial infarction or even other heart conditions STEMI - ST elevation Myocardial infarction NSTEMI - non ST elevation Myocardial infarction Heart muscles are damaged without SSx Atrial fibrillation (AF) A source for embolism Which leads to AMI or Stroke Ventricular fibrillation (VF) Lead to death Echocardiogram (ECHO) Investigate heart function Ejection fraction (EF with normal > 55-70%) check the volume of blood pumping to the atrium Valve integrity (tricuspid, pulmonary, mitral and aortic valves) Electrocardiogram Resources Local Hong Kong Resources: Smart patient, Hospital Authority https://www21.ha.org.hk/smartpatient/SPW/en-US/Home/