Cardiovascular Flashcards
What are the 2 main risk factors for CV disease?
- Smoking
- Genetics
What are some irreversible CV risk factors?
- age - risk increases with age
- sex - males generally higher risk than females
- family history - genetic risk
What are some reversible CV risk factors (patient)?
- smoking
- obesity
- diet
- exercise
What are some reversible CV risk factors (medical)?
- hypertension
- hyperlipidaemia (high cholesterol)
- diabetes
What are the key parts of risk modification?
- patient centres and controlled
- information
- belief
- motivation
- behavioural change
What are the 2 types of prevention?
- primary prevention
- secondary prevention
What does primary prevention for CV involve?
- exercise, diet and not smoking
- assess total risk - medical treatment if high risk
What does secondary prevention for CV involve?
- exercise, diet and not smoking
- medical treatment to reduce risk
What is primary prevention?
- stopping a disease before it happens
- looking at patient’s life style, risk factors, family history etc
What is secondary prevention?
stopping a second incident e.g. preventing a patient from having a second heart attack
What can be used to assess a patient’s risk for CV (primary prevention)?
opportunistic approach
* family history
* diet
* smoking
* test cholesterol
* test blood pressure
* test for diabetes (type 2)
What are 4 approaches to the prevention of CV disease?
- lifestyle changes
- control total cholesterol
- statin treatment
- reduce cholesterol <5.0mmol/L or 25%
- control hypertension
- moderate hypertension
- mild hypertension with evidence of CV disease
- reduce blood pressure to target of <140/85
- anti platelet drugs - aspirin
- when identified CV disease
- when high risk with no identified disease
Why do the dental team have a role in cardiac prevention?
- 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
What is hypertension?
raised blood pressure
* systolic >140mm Hg
* diastolic >90mm Hg
sitting and rested for at least 15 minutes
What are known risk factors for hypertension?
- age
- race
- obesity
- alcohol
- family history
- pregnancy
- stress
- drugs
- non steroidal
- corticosteroids
- oral contraceptives
- sympathomimetics
What is the highest risk of uncontrolled hypertension?
CVA (stroke)
In coronary heart disease, why won’t treating the hypertension have little effect to the patient’s risk?
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
In congestive heart failure does treating hypertension have a large effect to the patient’s risk?
Yes, has a large effect - reduces the work load of the heart, making the muscle more able to cope
What are the outcomes from hypertension?
- accelerated atherosclerosis
- myocardial infarction
- stroke
- peripheral vascular disease
- renal failure - which will then make hypertension worse
What are common triggers for hypertension?
- NONE usually found (essential hypertension)
- likely genetic failure of autoregulation control of blood vessel wall constriction
What are rare triggers for hypertension?
- renal artery stenosis
- endocrine tumours
- Phaeochromocytoma (adrenaline)
- Conn’s syndrome (aldosterone)
- Cushing’s syndrome (cortisol)
Why does increases adrenaline, aldosterone and cortisol increase blood pressure?
- adrenaline - vasoconstrictor
- aldosterone and cortisol - increases circulating blood volume
What are the signs and symptoms of hypertension?
- 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
What are the indications for further investigations of hypertension?
- young patient
- resistant hypertension despite ‘adequate’ treatment
- accelerated hypertension
- ‘unusual history’
What does Cushing’s syndrome cause?
salt and water retention - excess fluid within the circulation
What is renal artery stenosis?
narrowing of blood flow in kidneys
Why does renal artery stenosis cause hypertension?
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
What are the investigations for renal artery stenosis?
- urinalysis
- serum biochemistry (electrolytes, urea, creatinine)
- serum lipids
- ECG
occasionally: renal ultrasound, renal angiography, adrenaline and cortisol hormone estimations
How is hypertension treated?
- modify risk factors - weight loss, exercise
- single daily drug dose - improves compliance with medicine
What drugs can be used to treat hypertension, and what are their side effects?
- 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
What is the aim of treating hypertension?
BP < 120/90 mm Hg
What are some drugs used to treat hypertension?
- thiazide diuretic
- beta blockers
- calcium channel antagonists
- ACE inhibitors
What is a side effect of thiazide diuretic?
gout
What is a side effect of beta blockers?
can make COPD and asthma worse
What is a side effect of calcium channel antagonists?
gingival hyperplasia
What is a side effect of ACE inhibitors?
can make peripheral vascular disease worse
How often should hypertension treatment be monitored?
- ever 2-3 months until stable/adequate regime is found
- at least annually when stable
What blood biochemistry effects are important to monitor when using hypertension drugs?
- sodium and potassium changes
- dehydration
What are the 2 processes of ACS?
- blood vessel narrowing
- blood vessel occlusion
What does blood vessel narrowing result in?
ischaemia developing in the tissue supplied by the vessel - like getting cramp in the affected tissue which is felt as pain
What does blood vessel occlusion result in?
no oxygen delivery —> tissue death —> loss of function — cardiac arrest —> death
severe pain
What are the 3 coronary arteries?
- right coronary artery
- left anterior descending coronary artery
- circumflex coronary artery
