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BDS M5 Human Disease > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the 2 main risk factors for CV disease?

A
  1. Smoking
  2. Genetics
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2
Q

What are some irreversible CV risk factors?

A
  • age - risk increases with age
  • sex - males generally higher risk than females
  • family history - genetic risk
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3
Q

What are some reversible CV risk factors (patient)?

A
  • smoking
  • obesity
  • diet
  • exercise
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4
Q

What are some reversible CV risk factors (medical)?

A
  • hypertension
  • hyperlipidaemia (high cholesterol)
  • diabetes
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5
Q

What are the key parts of risk modification?

A
  • patient centres and controlled
    • information
    • belief
    • motivation
    • behavioural change
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6
Q

What are the 2 types of prevention?

A
  • primary prevention
  • secondary prevention
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7
Q

What does primary prevention for CV involve?

A
  • exercise, diet and not smoking
  • assess total risk - medical treatment if high risk
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8
Q

What does secondary prevention for CV involve?

A
  • exercise, diet and not smoking
  • medical treatment to reduce risk
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9
Q

What is primary prevention?

A
  • stopping a disease before it happens
  • looking at patient’s life style, risk factors, family history etc
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10
Q

What is secondary prevention?

A

stopping a second incident e.g. preventing a patient from having a second heart attack

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11
Q

What can be used to assess a patient’s risk for CV (primary prevention)?

A

opportunistic approach
* family history
* diet
* smoking
* test cholesterol
* test blood pressure
* test for diabetes (type 2)

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12
Q

What are 4 approaches to the prevention of CV disease?

A
  1. lifestyle changes
  2. control total cholesterol
    • statin treatment
    • reduce cholesterol <5.0mmol/L or 25%
  3. control hypertension
    • moderate hypertension
    • mild hypertension with evidence of CV disease
    • reduce blood pressure to target of <140/85
  4. anti platelet drugs - aspirin
    • when identified CV disease
    • when high risk with no identified disease
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13
Q

Why do the dental team have a role in cardiac prevention?

A
  • dentists see “well” patient regularly - doctors see you only occasionally when you are sick
  • opportunity foe dentist to deliver general health education messages as oral health education messages
  • opportunity for dentist to look at diet and lifestyle and offer advice and referral to support services - smoking cessation in particular
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14
Q

What is hypertension?

A

raised blood pressure
* systolic >140mm Hg
* diastolic >90mm Hg
sitting and rested for at least 15 minutes

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15
Q

What are known risk factors for hypertension?

A
  • age
  • race
  • obesity
  • alcohol
  • family history
  • pregnancy
  • stress
  • drugs
    • non steroidal
    • corticosteroids
    • oral contraceptives
    • sympathomimetics
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16
Q

What is the highest risk of uncontrolled hypertension?

A

CVA (stroke)

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17
Q

In coronary heart disease, why won’t treating the hypertension have little effect to the patient’s risk?

A

CHD is a slowly progressing disease - reversing high HP won’t reverse the atherosclerotic changes that have built up in the vessels over years of high BP

18
Q

In congestive heart failure does treating hypertension have a large effect to the patient’s risk?

A

Yes, has a large effect - reduces the work load of the heart, making the muscle more able to cope

19
Q

What are the outcomes from hypertension?

A
  • accelerated atherosclerosis
    • myocardial infarction
    • stroke
    • peripheral vascular disease
  • renal failure - which will then make hypertension worse
20
Q

What are common triggers for hypertension?

A
  • NONE usually found (essential hypertension)
  • likely genetic failure of autoregulation control of blood vessel wall constriction
21
Q

What are rare triggers for hypertension?

A
  • renal artery stenosis
  • endocrine tumours
    • Phaeochromocytoma (adrenaline)
    • Conn’s syndrome (aldosterone)
    • Cushing’s syndrome (cortisol)
22
Q

Why does increases adrenaline, aldosterone and cortisol increase blood pressure?

A
  • adrenaline - vasoconstrictor
  • aldosterone and cortisol - increases circulating blood volume
23
Q

What are the signs and symptoms of hypertension?

A
  • usually NONE
  • may get headache
    • more common in ‘malignant hypertension’ - where BP is rapidly accelerating
  • may get Transient Ischaemic Attacks
    • TIA’s are ‘mini strokes’
    • full neurological return in 24hrs
24
Q

What are the indications for further investigations of hypertension?

A
  • young patient
  • resistant hypertension despite ‘adequate’ treatment
  • accelerated hypertension
  • ‘unusual history’
25
Q

What does Cushing’s syndrome cause?

A

salt and water retention - excess fluid within the circulation

26
Q

What is renal artery stenosis?

A

narrowing of blood flow in kidneys

27
Q

Why does renal artery stenosis cause hypertension?

A

makes kidneys autoregulation system think BP has dropped because of hypovolemia
—> body will release renin, and through the renin angiotensin system aldosterone will be released, and salt and water will be retained

28
Q

What are the investigations for renal artery stenosis?

A
  • urinalysis
  • serum biochemistry (electrolytes, urea, creatinine)
  • serum lipids
  • ECG

occasionally: renal ultrasound, renal angiography, adrenaline and cortisol hormone estimations

29
Q

How is hypertension treated?

A
  • modify risk factors - weight loss, exercise
  • single daily drug dose - improves compliance with medicine
30
Q

What drugs can be used to treat hypertension, and what are their side effects?

A
  • thiazide diuretic (gout)
  • beta blocker (can make COPD and asthma worse)
  • calcium channel antagonist (gingival hyperplasia)
  • ACE inhibitor (can make PVD worse)

add multiple drugs in needed to get control

31
Q

What is the aim of treating hypertension?

A

BP < 120/90 mm Hg

32
Q

What are some drugs used to treat hypertension?

A
  • thiazide diuretic
  • beta blockers
  • calcium channel antagonists
  • ACE inhibitors
33
Q

What is a side effect of thiazide diuretic?

A

gout

34
Q

What is a side effect of beta blockers?

A

can make COPD and asthma worse

35
Q

What is a side effect of calcium channel antagonists?

A

gingival hyperplasia

36
Q

What is a side effect of ACE inhibitors?

A

can make peripheral vascular disease worse

37
Q

How often should hypertension treatment be monitored?

A
  • ever 2-3 months until stable/adequate regime is found
  • at least annually when stable
38
Q

What blood biochemistry effects are important to monitor when using hypertension drugs?

A
  • sodium and potassium changes
  • dehydration
39
Q

What are the 2 processes of ACS?

A
  • blood vessel narrowing
  • blood vessel occlusion
40
Q

What does blood vessel narrowing result in?

A

ischaemia developing in the tissue supplied by the vessel - like getting cramp in the affected tissue which is felt as pain

41
Q

What does blood vessel occlusion result in?

A

no oxygen delivery —> tissue death —> loss of function — cardiac arrest —> death

severe pain

42
Q

What are the 3 coronary arteries?

A
  • right coronary artery
  • left anterior descending coronary artery
  • circumflex coronary artery

BDS M5 Human Disease (13 decks)

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