Cardiovascular Disease

Question 1

Cardiovascular disease (CVD) includes…

Answer 1

> Atherosclerosis and associated conditions
Infections
Electrical impulse generation and conduction defects
Congenital Heart Disease

Question 2

Atherosclerosis and associated conditions of CVD?

Answer 2

> Raised BP (hypertension)
> Coronary Heart Disease (CHD)
> Chronic Heart Failure (CHF)
> Cerebrovascular Disease (stroke)
> Peripheral Artery Disease (DVT)

Question 3

Infections of CVD?

Answer 3

> Endocarditis

> Rheumatic Heart Disease

Question 4

Prevention of CVD

Answer 4

1. Primary prevention

2. Secondary prevention

Question 5

Primary prevention of CVD…

Answer 5

> when the patient has NO cardiovascular disease (otherwise healthy)
using drugs to PREVENT developing any CVD

Question 6

Secondary prevention of CVD…

Answer 6

> when the patient HAVE cardiovascular disease

> using drugs to TREAT/STOP them from having another one

Question 7

CV Risk Assessment

Answer 7

In adults with NO KNOWN CVD, a comprehensive assessment of CVD risk includes consideration of the following: modifiable and non-modifiable risk factors, related conditions

Question 8

Non-modifiable risk factors..

Answer 8

> Gender and Age
Family history of premature CVD
Social history including cultural ethnicity, and socioeconomic status

Question 9

Age and Gender

Answer 9

> Risk increases with increasing age.

> CVD risk is higher in male than female (starts at 40)

Question 10

Family history: relative risk?

Answer 10

Significant family history: Clinically proven CVD in a first-degree relative before the age of 55 (male) and 65 (female).

Question 11

Ethnicity: Indigenous & Non-Indigenous

Answer 11

Prevalence among Indigenous = non-Indigenous Australians who are 10 years older.
May influence risk by multiple mechanism:
>Genetics
>Lifestyle: smoking, poor nutrition & overweight, diabetes
>Psychosocial

Question 12

Psychosocial?

>Stress & CVD

Answer 12

> no confirmed relationship btwn stress and CVD
but there is CONFIRMED increased risk for CVD in people who live with: social isolation, depression, lack of social support

Question 13

Socioeconomic status: Low-Middle socioeconomic groups

Answer 13

Why?
>increased incidence of major risk factors: including psychosocial risk factors
>Low nutrition
>Low education

Question 14

Modifiable risk factors…

Answer 14

Smoking, BP, serum lipids, waist circumference & BMI, nutrition, physical activity level, alcohol intake

Question 15

Smoking risk of CVD..

Answer 15

2-6 times higher and risk of stroke is 3 times higher!

Question 16

BP & serum lipids..

Answer 16

use drugs like ACE-inhibitors and HMGCoA reductase inhibitors (statins)

Question 17

Physical activity…

Answer 17

at least 30 minutes on days of a week
>more intense and frequent activity does confer greater protection
>but be careful on counselling for doing physical activity in ppl who hv angina for ex. so refer to specialist.

Question 18

Related conditions to CVD

Answer 18

Diabetes, Chronic Kidney Disease (CKD), Familial Hypercholesterolaemia, Evidence of Atrial FIbrillations (AF)

Question 19

Absolute CVD Risk is……?

Answer 19

> based on Framingham heart study.

>a CV Risk Calculator to predict the likelihood of someone to experience a CV event

Question 20

Infectionsss of the heartt

ENDOCARDITIS

Answer 20

> infection of the endocardial surface of the heart

Question 21

HOWW can endocarditis happen?

Answer 21

bacteria enter bloodstream -> lodge on abnormal heart valve/other damaged heart tissue (minor surgery, valve replacement, IV drug use)

Question 22

Symptoms of endocarditis (commonly vague)

Answer 22

> fever and chills
heart murmurs
congestive heart failure
secondary embolic phenomena

Question 23

Causative organisms?

Answer 23

dependant upon site –> bacteria in the blood
Gram+ : Staphylococcus, Streptococcus, Enterococcus
Gram - : HACEK group
Fungal : Candida

Question 24

Steps to treat endocarditis..

Answer 24

1. Take blood to do blood cultures –> BEFORE any antibiotic given!
2. Give empirical treatment

Question 25

Endocarditis empirical treatment

>to cover all relevant G+ and G- organisms

Answer 25

REFER TG FOR COMPLETE NOTE
Benzylpenicillin 1.8g IV, 4-hourly
and
Di/Flucoxacillin 2g IV, 4-hourly
and
Gentamicin 4-6mg/kg IV for 1st dose, then determine dosing interval if needed for subsequent doses based on renal fx