35. Heart disease

Question 1

What is coronary heart disease?

Answer 1

Narrowing of the coronary arteries due to the build up of plaque within due to fat deposition (atherosclerosis)

Question 2

What is the mortality rate of coronary heart disease (CHD)?

Answer 2

CHD accounts for 50% of cardiovascular disease deaths

Question 3

What are the major risk factors for CHD?

Answer 3

Hypertension
High cholesterol
Obesity
Diabetes

SO to reduce the levels of CHD, need to reduce the levels of these risk factors

Question 4

What lifestyle measures can be implemented to prevent CHD?

Answer 4

Stop smoking - vital
Alter diet to achieve normal weight and BMI for adults
Reduce salt intake to <100mmol/day
Limit alcohol consumption to <3 u/day for men and <2 u/day for women
Regular aerobic exercise (brisk walking) for >30 minutes per day
Consume at least five portions/day of fresh fruit and veg
Reduce sugar intake

Question 5

What is the NICE recommended antihypertensive drug treatment?

Answer 5

A - ACE inhibitor or low-cost angiotensin II receptor blocker (ARB)
C - Calcium-channel blocker (CCB)
D - Thiazide-like diuretic

Aged under 55 years - A –> A+C –> A+C+D and any further than this is resistant hypertension requiring expert advice

Aged over 55 years or black person of African or Caribbean family origin of any age - C –> A+C –>A+C+D –> resistant hypertension

Question 6

Give the actions of antihypertensive drugs and what their side effects may be

Answer 6

Calcium antagonistics - vasodilate BUT can cause flushing or oedema
ACE inhibitors - inhibit renin/angiotensin/aldosterone system (RAAS) and cause vasodilation BUT can cause a cough and a low BP
Angiotensin receptor blocker - block the action of angiotensin II and hence cause vasodilation BUT can cause a low BP
Thiazides - Salt and water loss BUT can cause hypokalemia
Beta blockers - slow the heart rate and reduce renin secretion BUT can cause lethargy and bronchospasm

Question 7

What is the treatment for myocardial infarction?

Answer 7

60% humidified oxygen
Opirates (opium) for pain relief
Aspirin - limits the infarction size
Thrombolysis/primary angioplasty - revascularisation

Question 8

What is the secondary prevention for after an MI?

Answer 8

Beta blockers
Reduce rhythm problems
ACE inhibitors
Prevent heart failure
Statins
Reduce cholesterol
Lifestyle and risk factor modification

Question 9

What drugs are included within the Polypill?

Answer 9

Statin
BP reduction drugs
Antiplatelet - aspirin 75mg
Folic acid