Cardiovascular disorder

Question 1

Artherosclerosis

Answer 1

Is a disease in which the inside of an artery narrows due to the build up of plaque.

Question 2

Traditional view of Artherosclerosis

Answer 2

• Lipid accumulation and calcification
• Artery wall damages (smoking, high blood pressure, stress, LDL)
• Lipids and salta accumulates on the damages artery wall –> plaque is formed

Question 3

Modern view of artherosclerosis

Answer 3

inflammatory processes are present in each stage -> the important of immune system

Question 4

Hypertension

Answer 4

Pressure on the artery walls during contraction and relaxation of the heart

Question 5

Types of hypertension

Answer 5

• Essential
• Secondary (consequence of renal disease or hormonal problems)
• “white coat”
• During pregnancy

Question 6

Blood pressure values (normal)

Answer 6

SBP < 120

DBP < 80

Question 7

Blood pressure values (high)

Answer 7

SBP <140

DBP > 90

Question 8

Hypertension; main problem

Answer 8

Non-adherence, about 50% of patient do not take their medicine as prescribed

• Lack of treatment is the main cause of the CV-consequences of hypertension

Question 9

Hypertension; psychological focus

Answer 9

1. enhancing complience
2. exercies
   - lowers blood pressure 3-5 a week, 30 minutes is enough (more is not better)
   - exercise may serve as the only therapy requires in some mild hypertensive subjects

Question 10

Types of cerebrovascular disease (stroke)

Answer 10

• Ischaemic stroke: the blood vessels is blocked, and not sufficient blood supply
• Haemorrhagic stroke: bleeding
• Transient ischemic attach: symptoms resolved within 24 h.

Question 11

Symptoms of stroke

Answer 11

FAST (Facial weakness, Arm weakness, Speech problems, Time to call 999)

• Unilateral symptoms in most cases
• Hemiplegia
• Inability to produce speech
• Altered vision
• Altered movement coordination
• Loss of consciousness

Question 12

Consequences of stroke

Answer 12

• The main cause of long-term disability
• Depend on the brain area affected and the size of the damage
• Also depend on time between the onset of symptoms and the treatment

Question 13

Types of heart diseases

Answer 13

Ischaemic heart disease:

• Angina pectoris
• Myocardial infarction

Acute coronary syndrome

• Unstable angina
• Myocardial infarction

Arrtyhmia

Heart failure

Sudden cardiac death

Question 14

Symptom and diagnostic criteria of heart disease

Answer 14

Chest pain radiating into the shoulders, arms, neck or lower jaws

May be atypical (especially in woman)

Question 15

Criteria of myocardial infarction

Answer 15

Two out of the following:

• chest pain
• elecated enzyme levels
• changes in ECG

Question 16

Risk factors for CVD

Answer 16

Modifiable and non-modifiable

Behavioral risk factors account for 80% of coronary disease and stroke

Risk factors tend to co-occur, especially in people with low SES

Question 17

Non-modifiable risk factors of CVD

Answer 17

age
sex
genetics (family history of CVD, ethnicity)

Question 18

Modifiable risk factors of CVD

Answer 18

smoking
high cholesterol level
high blood pressure
diabetes
sedentary life style
overweight, obesity
stress (psychosocial risk factor)
alcohol consumption

Question 19

Psychosocial risk factors of CVD

Answer 19

hostility
anger
type a behavior pattern
depression and related concepts (hopelessness, fatigue, exhaustion)
anxiety
low social support

Question 20

Coronary heart disease (psychosocial factors)

Answer 20

Two major topics

1. hostility, anger, type A behavior pattern
2. Negative emotionality: depression, anxiety and related notions (vital exhaustion, hopelessness, fatigue)

Question 21

Type A behavior pattern (TABP)

Answer 21

Rosenman and Friedman = at the end of 1950 (cardiologists)

“combination of certain personality traits such as excessive competitive drive, persistent desire for recognition, advancement and achievement, and peristent inclination on one hand and of chronic immersion in “deadlines” on the other hand”

Charcateristics:

• time urgency, impatience
• free-floating hostility
• competiviteness

Question 22

Measuring type A behavior

Answer 22

Self-assessment:
Time urgency:
- symptoms: hurrying while walking, eating, extreme punctuality, intense aversion to having to wait in a due

• psychomotor signs: chronic facial tension, tense posture, quick speech, excessive facial sweat

Fluctuating hostility:
- Symptoms: frequently getting angry while driving, grinding of teeth, irritability easily provoked, discomfort when having to face pretty mistake

• psychomotor signs: facial hostility, tightening the hand during a conversation, hostile laughter

Question 23

ARIC study on anger and CVD

Answer 23

high trait anger -> significant higher rate of cardiac death

Question 24

Framinghan heart study and CVD

Answer 24

suppressed hostility is an independent risk factor of CHD in both sexes

Question 25

Rosenman and Friedman

Answer 25

Type A behavior

Question 26

Physiological mechanisms of hostility and anger + CVD

Answer 26

Cardiovascular reactivity changes in response to physical or psychological stressors.

Question 27

Hostile person and psychological mechanisms

Answer 27

exaggerate cardiovascular reactivity. SNS activity increase lead to higher blood pressure and heart rate.

Question 28

Why does anger episode trigger infarction?

Answer 28

When anger --> arteries contract, higher blood pressure which leads to changes in the blood flow which then leads to plaque may rupture.

Question 29

Social support and hostility

Answer 29

Increased hostility leads to increased interpersonal conflicts which again leads to difficulties in their close relationship as well. So, hostility = low social support.

Question 30

Health behavior and hostility

Answer 30

Perceived importance of health behavior may be lower; does not care about the harmful consequences of health damaging behaviors. Non-adherence is more frequent.

Question 31

Depression and the development of CHD

Answer 31

Meta analysis: found a connection between depression and later CHD. Depressive people have 64% change of getting CHD.

Question 32

Hopelessness increases the risk of..?

Answer 32

ischemic heart disease or cardiac death

Question 33

How does heart patient express depression?

Answer 33

They complain less directly, and they tend to normalize depression by regarding their symptoms as a consequence of their heart disease. Less typical symptoms: anxiety, irritability

Question 34

Anxiety in CHD

Answer 34

Anxiety is the earliest and most intensive psychological reaction to MI. High anxiety after infarction is an independent predictor of complication in the hospital.

Question 35

psychological mechanisms of depression and anxiety

Answer 35

- Both HPA axis and SNS are over-stimulated - higher level of catecholamines and cortisol leads the wall of the blood vessels to be damaged. - High anxiety: high level of coagulation markers.

Question 36

Anxiety as trigger of acute events

Answer 36

Acute anxiety leads to catecholamines to suddenly rise which again leads to: - heart rate and blood pressure increase, the oxygen need of the heart muscle increases too. - Excitability of the heart muscle is high which leads to that arrhythmia develops easier.

Question 37

Acute coronary syndrome (ACS)

Answer 37

Is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. Most cases are caused by the rupture of an atherosclerotic plaque. The degree of arterial blockage determines the amount of myocardial damage.

Question 38

Most common cause of death in both developing and developed countries?

Answer 38

Acut coronary syndrome

Question 39

Acute coronary syndrome secondary prevention

Answer 39

Mediterranean diet Alcohol consumption Physical activity status Smoking status

Question 40

Mediterranean diet

Answer 40

Increased intake of fruit, vegetables, fish. 50-70% lower risk of recurrent heart disease event

Question 41

Alcohol consumption (ACS prevention)

Answer 41

Moderate consumption of wine during meals could reduce mortality, while wine drinking outside meals increased mortality rates.

Question 42

Physical activity status (ACS prevention)

Answer 42

The most important non-pharmaceutical mean for secondary CVD prevention

Question 43

Smoking (ACS secondary prevention)

Answer 43

CVD patient who quit smoking reduce their CVD death rate by about 40%. cognitive behavioral methods intend to explain and predict healthy behaviors and can ultimately contribute to implementation of more effective health promotion strategies.

Question 44

Motivation and behavioral change in CVD patients

Answer 44

only intrinsic motivation was a significant predictor of the maintenance of long-term physical activity. CVD patient need to feel motivated, but also effective, toward physical activity for the initiation of it.

Question 45

Intervention for motivation and self-efficiency on behavioral change in CVD patient

Answer 45

Should be based on supporting autonomy and competence. - improve patients perception about their abilities to adopt healthy eating habits - help them take small steps - encourage them and support their achievements and attribute their accomplishments to their abilties

Question 46

Psychological interventions on CVD (linden et al.)

Answer 46

Intervention focusing only on psychological factors lowered long-term mortality by 43%. Focus must be on psychological distress: lowers heart rate, rate of cholesterol, raise social support and QoL.

Question 47

psycholgoical internvetions (CVD) - relaxation

Answer 47

lower HR | the prevalence of cardiac event lowered to half > even long term effect.

Question 48

psychological intervention (CVD) - treating type A behavior

Answer 48

Very effective: combined interventions; education, relaxation, cognitive restructuring, behavior modifications.