Cardiovascular disease is a general term for conditions affecting the heart or blood vessels. Cardiovascular disease includes all the diseases of the heart and circulation such as ischemic heart disease, angina, heart attack and congenital heart disease.
Cardiovascular diseases are usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) that cause a narrowing of blood vessels and an increased risk of blood clots.
Cardiovascular diseases are one of the most common diseases in Europe and are a major cause of death and disability; therefore, their prevention and management are of paramount importance.
There are many different types of cardiovascular disease. Here, by way of example, we present Ischemic Heart Disease, which is the most common condition in this category.
The case of ischemic heart disease
Age: 50 year old
The case of Carlo that has got an ischemic heart attack
Carlo is a receptionist; his work is sedentary and on shifts, often at night. Recently he has been experiencing a sort of heaviness or tightness in the chest, which sometimes turns into real pain. After a medical examination, he was diagnosed with ischemic heart disease. He was absent from work for a period, to undergo further medical check-ups and to avoid job strain and work-related stress.
Now Carlo would like to return to his normal routine as soon as possible, but his doctor recommended he avoid shift work: he hopes his manager will agree to this condition and let him continue working with some adjustments.
Ischemic Heart Disease (IHD)
1 What is it
Ischemic heart disease is the main form of cardiovascular diseases (CVD).
Ischemic heart disease (IHD) is when the coronary arteries that supply the heart muscle with oxygen-rich blood become narrowed by a gradual build-up of fatty material within their walls. Over time, this fatty material, called atheroma, can build up inside the walls of the arteries. This is known as atherosclerosis. Eventually, as atherosclerosis progresses and worsens, the arteries may become so narrow that they cannot deliver enough oxygen-rich blood to the heart. If a piece of atheroma breaks off it may cause a blood clot (blockage) to form. If it blocks the coronary artery and cuts off the supply of oxygen-rich blood to the heart muscle, this can result in a heart attack. Depending on the severity of the heart attack and/or the time when interventions or treatments commence, a heart attack can lead to permanent damage to the heart muscle and result in heart failure.
The main symptom of ischemic heart disease is angina: a pain or discomfort felt in the chest area. Angina often feels like a heaviness or tightness in the chest, which may also spread to the arms, neck, jaw, back or stomach. Some people describe a feeling of severe tightness, while others say it is more of a dull ache. Some people also experience shortness of breath, dizziness and nausea. Angina symptoms are often brought on by physical activity, an emotional upset, cold weather or after a meal.
In the first instance, prevention of the development of ischemic heart disease by living a healthy lifestyle is of paramount importance. Emphasis is placed on an individual knowing their own risk factors for IHD and applying measures to manage these. The following will help to prevent IHD and also help those already diagnosed with IHD and/or angina in order to manage their condition and symptoms: avoiding or stopping smoking; getting plenty of exercise (minimum 150 minutes moderate intensity exercise per week); a healthy diet (rich in fruits, vegetables and whole grains and low in saturated/trans fats and salt); maintaining a healthy weight (losing weight to achieve this if necessary); reducing high blood pressure and high cholesterol; and managing diabetes.
Some people need operations such as coronary angioplasty with stents or heart bypass surgery to treat their IHD and angina.
Several medications are routinely prescribed for IHD and angina:
- Aspirin – an anti-platelet medication to prevent blood clots
- Statins – medication to lower cholesterol levels
- Nitrates – short or long acting (which contain nitroglycerin) to dilate the coronary arteries and increase oxygen-rich blood to the heart muscle
- Calcium channel blockers – to relax the walls of the coronary arteries and lower blood pressure
- Beta blockers- to slow the heart rate, reduce oxygen demand on the heart and reduce the frequency of angina attacks
Some of these medications may also be prescribed for individuals who are at significant risk of developing cardiovascular disease, to reduce the risk of heart attack or stroke in the future.
4 Psychosocial issues and impact of the disease on employment
People react in different ways when they have had an ischemic hearth attack or when are told that they have a heart condition. Some people want to get back to their normal routine as soon as possible, whereas others decide to change certain areas of their life, such as the type of work they do or where they live. Most people do return to work even though they have been diagnosed with a heart condition or have had a heart procedure in hospital.
To manage workers with ischemic heart disease and help them continue working or return to work, employers can promote some interventions.
A general recommendation is to support free and frank communication between the employer and the employee with ischemic heart disease during the whole process right from first episode.
Since the causes of heart disease can be influenced by lifestyle factors and workplace features of various kinds, the employer should pay particular attention to some factors that might require accommodation, such as workplace adaptation, job type changes or daily schedule modifications:
- Physical factors: extreme temperature, noise, vibration can raise blood pressure and make pre-existing heart problems worse.
- Chemical factors: a number of toxins that may be used in the workplace have been found to increase the risk of heart disease (e.g. carbon monoxide, methylene chloride, carbon disulphide).
- Psychosocial factors: job strain (a combination of high work demands with low job control and low decision-making power), effort/reward imbalance, high level of vigilance required, work-related stress, sedentary work, shift work.
Depending on the heart condition diagnosed or treated, an employee’s cardiologist and/or general physician would normally provide advice regarding the individual’s abilities and/or limitations. This advice can then be forwarded to the employer’s Occupational Health Department. Certain factors must be taken into consideration when an individual has been diagnosed with a heart condition and/or is having on-going treatment before s/he returns to work:
- Functional capacity of the individual
- Consideration of any medical implantable devices (e.g. pacemaker, implantable cardioverter defibrillator)
- Prognostic indicators and risk of recurrence
- Prevalence and management of on-going symptoms
- Requirements concerning attending medical appointments
- Flexibility concerning working hours/shift patterns