Cardiovascular Issues in Primary Care

Question 1

How do we define cardiovascular disease?

Answer 1

All conditions that affect the heart and circulation

Question 2

How do CVDs affect the quality of life?

Answer 2

Can impact quality of life and impacts their physical abilities. It can cause considerable disability, fatigue, oedema, and sleeping difficulties.

Question 3

What are the types of prevention used?/Public health agenda

Answer 3

Primary Prevention: Designed to reduce instances of an illness in population and to reduce their duration.

Secondary Prevention: Aimed at detecting (annual checks: blood monitoring tests) and treating symptomatic disease (pharmacists involved in this stage: NMS reviews- bp2134).

Tertiary Prevention: Activities aimed at reducing the incidence of recurrences of chronic incapacity among those with symptomatic CVD.

Question 4

What are the key risk factors for CVD

Answer 4

unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol etc.

Question 5

What are non-modifiable risk factors?

Answer 5

age, gender and ethnicity

Question 6

How do we classify hypertension?

Answer 6

Pre-hypertension: systolic pressure from 120 to 139 mm Hg or a diastolic pressure from 80 to 89 mm Hg.

Stage 1 hypertension: Clinic BP is 140/90mmHg or higher and subsequent ambulatory BP monitoring (ABPM) daytime average or home BP monitoring (HBPM) average blood pressure is 135/85mmHg or higher.

Stage 2 hypertension: Clinic BP is 160/100mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95mmHg or higher.

Severe hypertension: Clinic systolic BP is 180mmHg or higher or Clinic diastolic BP is 110mmHg or higher.

Question 7

What are some hypertension risk factors?

Answer 7

1. Increasing age (50% of the population aged over 60 years have hypertension)
2. Ethnicity hypertension is more prevalent in patients of Black African or Caribbean descent
3. Being overweight or obese ● Physical inactivity
4. Excess salt consumption
5. Excess alcohol intake
6. Stress
7. Other medical conditions (e.g. diabetes, chronic kidney disease, sleep apnoea).

Question 8

Nice guidance for hypertension?

Answer 8

Step 1:
● Under 55 years ACEI or A2RB (not combined)

● Over 55 years or African/Caribbean family heritage Calcium Chanel Blocker (If a CCB is not suitable, e.g. because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic)

● If diuretic treatment is to be initiated or changed, offer a thiazide-like diuretic, such as indapamide) in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.

Question 9

What are the consequences of hypertension?

Answer 9

If left untreated or poorly managed, hypertension can lead to the following medical conditions:

1. Stroke
2. Coronary heart disease
3. Left ventricular hypertrophy (thickening of the wall of the heart’s main pumping chamber)
4. Large vessel arterial disease
5. Heart failure
6. Renal disease
7. Retinopathy (damage to the eye)

Question 10

Give examples of counselling advice for patients with hypertension

Answer 10

• Weight loss (even as little as a 10 – 20# wt. loss can significantly lower blood pressure) if you are overweight/obese
• Decrease salt intake (sodium)
• Decrease alcohol intake
• Increase physical activity
• Stress reduction
• Stop smoking
• Certain diets (e.g. DASH) that are high in fruits & vegetables and low fat dairy products may be as effective as monotherapy with one antihypertensive drug.

Question 11

Define Hyperlipidaemia

Answer 11

Hyperlipidaemia is a family of disorders that are characterized by abnormally high levels of lipids (fats) in the blood. While fats play a vital role in the body’s metabolic processes, high blood levels of fats increase the risk of coronary heart disease (CHD).

Question 12

What are the current NHS guidelines on lipid levels

Answer 12

Total cholesterol→ 5 or below

HDL (good cholesterol)→1 or above

Non-HDL (bad cholesterol)→4 or below

Question 13

What causes hyperlipidemia?

Answer 13

Lifestyle, other diseases (kidney disease, pcos, diabetes etc), medication (corticosteroids, beta blockers etc)

Question 14

What are the normal ranges for total cholesterol, HDL, and Fasting TG’s?

Answer 14

NORMAL’ RANGES FOR TC, HDL & TGS
● Total cholesterol:
● <5.2mmol/L – ideal, 5.2-6.2mmol/L - acceptable / borderline, >6.22mmol/L is HIGH

● HDL:
● Ideal is > 1.1mMol/L
● Fasting TGs: <2.26mmol/L – normal, 2.26 – 4.52 mmol/L – borderline: high, 4.52 – 11.29 mmol/L >11.29mmol/L Very High

Question 15

Give examples of risk factors associated with hyperlipidemia.

Answer 15

1. Hereditary factors
2. Other disorders, such as diabetes mellitus, kidney disease and hypothyroidism, may promote hypertriglyceridemia.
3. Diet high in saturated fat and cholesterol
4. Certain drugs – refer to Dr Pritchard’s lecture
5. Obesity
6. Smoking
7. Physical inactivity

Question 16

What nutritional advice can be given to patients for the management of hyperlipidemia?

Answer 16

Replace foods containing saturated fats with those that contain polyunsaturated and monounsaturated fats
. You can do this by choosing healthy fats such as olive or rapeseed oil, nuts, seeds, fish and avocado. Increase your fibre intake by choosing vegetables, fruits, wholegrains, pulses, nuts and seeds every day.

Take vitamin C

Question 17

Cholesterol testing?

Question 18

What things should pharmacists look out for in CVD patients?

Answer 18

● Worsening symptoms – breathlessness, chest pain etc = red flags
● Interactions with OTC meds
● Cold/Flu remedies
● Na+ content
● Soluble paracetamol ● Antacids
● Cystitis preps

Question 19

Define Angina

Answer 19

ngina is chest pain that occurs when the blood supply to the muscles of the heart is restricted. It usually happens because the arteries supplying the heart become hardened and narrowed.
● The pain and discomfort of angina feels like a dull, heavy or tight pain in the chest that can sometimes spread to the left arm, neck, jaw or back.

Question 20

Give examples of Angina medications.

Answer 20

● Anti-arrhythmics – e.g. Verapamil, digoxin, amiodarone ● NB. Lots of interactions with these meds
● Also Nitrates used (timings! Tolerance)
● In community likely to see people requiring GTN

Question 21

Define GTN

Answer 21

A nitrate that provides immediate relief from symptoms of angina. It can also be used as a preventative measure before doing activities known to trigger angina, such as exercise.
It is a vasoconstrictor so increases the blood supply to the heart.
● GTN sprays and tablets available OTC
Has Issues with stability etc
● Chest pain – non responsive to GTN (is it in date, is it an MI?