Cardiovascular Dysfunction Flashcards
Definition - cardiovascular disease
NICE, 2014
British Heart Foundation, 2015
No universally agreed definition…
Cardiovascular disease (CVD) describes disease of the heart and blood vessels caused by the process of atherosclerosis. It is the leading cause of death in England and Wales accounting for almost one third of deaths (NICE, 2014)
Cardiovascular disease (CVD) includes all the diseases of the heart and circulation including coronary heart disease, angina, heart attack, congenital heart disease, heart failure and stroke. (British Heart Foundation, 2015)
What disordered are included in CVD?
CVD tends to incorporate hypertension, ischaemic heart disease, angina pectoris, myocardial infarction, stroke, rheumatic
heart disease, congenital cardiac defects and
heart failure
Most of the diseases grouped under the
heading CVD are inter-related (e.g. stroke and hypertension = same process)
What causes heart failure?
- CVD is the primary aetiology of heart failure, although a variety of other factors also cause heart failure
(e.g. Heart valve defects caused by diseases such as
rheumatic fever or infection, primary disease of the
heart muscle known as cardiomyopathy, and
congenital heart disease)
- Much CVD is caused by atheromatous plaque build up
on the intima or inner layer of the arterial wall
Risk factors for CVD?
- Age
- Sex (More M)
- Family history of CVD
- Ethnic background
- Smoking
- Raised Blood Pressure
- Raised Cholesterol
- Low income/social deprivation (north/south divide)
Air pollution
Cholesterol…
What is
Total cholesterol
‘Good’ cholesterol
‘Bad’ cholesterol
Triglycerides
total cholesterol – the overall amount of cholesterol in
your blood, including both “good” and “bad”
cholesterol
good cholesterol (called HDL) – this makes you less
likely to have heart problems or a stroke
bad cholesterol (called LDL and non-HDL) – this
contributes to atherosclerosis and makes you more
likely to have heart problems or a stroke
triglycerides – a fatty substance similar to bad
cholesterol and considered the building blocks of
cholesterol
High levels of triglycerides and low levels of HDL raise
your risk for heart disease
Normal values for:
Total cholesterol
‘Good’ cholesterol
‘Bad’ cholesterol
Triglycerides
Normal
Total cholesterol - 5 or below
‘Good’ cholesterol - 1 or above
‘Bad’ cholesterol- 4 or below
Triglycerides - 2.3 or below
Lifestyle factors ?
Stress Personality - 'type a' Smoking Sedentary lifestyle CVD - brain and heart
Genetic link
- Genetics can influence the risk for heart disease. A
family history of cardiovascular disease (CVD) modifies
future risk of CVD depending on the number and age of
affected first-degree relatives
-Many cardiac disorders can be inherited, including
arrhythmias, congenital heart disease, cardiomyopathy,
and high blood cholesterol
- CHD leading to heart attack, stroke, and heart failure
can run in families - The gene variant ADAMTS7 is linked to a build up of plaque in the coronary arteries and is one of a number of genes associated with heart disease risk identified within the last few years
- Variants on chromosomes 9, 6 and 2, as examples, are also associated with heart
disease
Foetal Origins Hypothesis
David Barker
The Barker hypothesis states that adverse influences early in development, and particularly during intrauterine life, can
result in permanent changes in physiology and metabolism, which result in increased disease in adulthood
- This hypothesis originally evolved from observations by Barker and colleagues that the regions in England that had the highest rates of infant mortality in the early twentieth century also had the highest rates of mortality from coronary heart disease decades later
- The fetal origins hypothesis states that fetal under-nutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease
Like other living creatures in early life,
human beings are “plastic” and able to
adapt to their environment.
The development of the sweat glands in first 3 years of life provides a simple example of this
Plasticity allows a ‘weather forecast’ - if mother is poorly nourished, baby expects environment to be harsh. This leads to reduced size and altered metabolism.
Disparities between predicted environment and actual environment then results in disease
e.g. diabetes, hypertension
Rapid weight gain in early childhood is associated with CVD
Links between cardiovascular factors & babies?
A substantial number of published studies suggest
that impaired fetal growth is related to higher risk of
hypertension, diabetes and CVD.
- Recent studies point to a particularly high risk of
cardiovascular disease in overweight or obese subjects with a history of impaired fetal growth and in subjects who experienced accelerated growth in childhood - Neonatal abdominal circumference has also been
shown to predict plasma cholesterol and fibrinogen
levels in men in later life-CVD linked - Babies born small in relation to the size of their
placenta have an increased risk of developing
hypertension - On the other hand babies who were reported to have
small placentas in relation to their birth weight are
more at risk of developing type 2 diabetes, sometimes
in combination with hypertension - Babies born small tend to have higher basal plasma
cortisol levels
Links with birth weight
Babies born small in relation to the size of their placenta have an increased risk of developing:
- Hypertension
- Coronary heart disease
- Non-insulin dependent diabetes
- Stroke
- Dislipidaemia
- Elevated clotting factors
- Impaired neuro-development
less well replicated inc.
depression
schizophrenia
lung disease
High birth weight -
polycystic ovary disease
Heart oxygen journey?
deoxygenated blood enters the Right Atrium, travels into the right ventricle, travels into the lungs via the pulmonary artery, oxygenation happens, then via pulmonary VEIN (oxygenated) into Left Atrium,then into left ventricle, via aorta into body, deoxygenated back to RA via vena cava
What illnesses are meant by: Acute Coronary Syndrome?
Includes The term 'acute coronary syndromes' encompasses a range of conditions including unstable angina, non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI).
Whats the differene between Non-ST elevation MI and Unstable Angina?
Non-ST elevation MI is an unstable coronary syndrome which is differentiated from unstable angina by a subsequent rise in cardiac
enzymes.
NICE (2011) clinical guideline 94 – Unstable angina and NSTEMI
What is the disease process of ACS?
- This process is generally initiated by the
fissuring of an atheromatous plaque in the
coronary artery. - The extent to which the fissuring reduces
the blood flow to the myocardium determines the nature of the clinical events.
