CVD - Atherosclerosis and risk factors

Question 1

Why is cardiovascular disease important?

Answer 1

National records of Scotland report majority of Scottish people die from CVD. 5 of the top 10 reasons of death in Scotland are CVD in nature

Question 2

What is atherosclerosis?

Answer 2

Main cause of vascular disease in developed world. Affects brain, heart, aorta, kidneys, gut and legs

Question 3

Describe the pathogenesis of Atherosclerosis:

Answer 3

A progression over time as inflammation increases, causing a large plaque within the arterial wall.

Starts with:

• endothelial damage
• chronic inflammation
• lipids and fibrous tissues accumulate
• atheromatous plaques develop

Question 4

How does atherosclerosis affect arteries?

What symptoms may present?

Answer 4

Progressive narrowing of artery reduces flow of blood and delivery of oxygen to tissues leading to ischaemic symptoms.

• cardiac angina: chest pain on exertion
• intermittent claudication in legs: tight pain in calves
• mesenteric angina in guts: abdominal paain after meals

Question 5

When does atheroscleroris present with danger?

Define the terms ischaemia and infarction:

List some examples of infarction and what they cause:

Answer 5

Danger comes when plaque ruptures:

• causes thrombus to form over the plaque, blocks artery, leads to symptoms of infarction (tissue death)

Ischaemia - reduces blood flow through artery

Infarction - no blood getting through

Causes - myocardial infarction (death of myocardium)

• cerebral infarction (stroke)
• gangrene of legs
• mesenteric infarction (often fatal)

Question 6

List some non-modifiable risk factors for atherosclerosis:

Modifiable risks:

Answer 6

Non-modifiable factors:

• genetic predisposition
• increasing age
• males greater risk than females

Modifiable:

• smoking
• hypertension
• high cholesterol - hypercholesterolemia
• diabetes mellitus
• overweight or obesity
• harmful use of alcohol

Question 7

What causes high cholesterol?

How can this be managed?

Answer 7

Causes:

• lifestyle or genetic contribution

Management:

• dietary modification
• exercise
• drugs - statins eg. atorvastatin, simvastatin

Question 8

How is blood pressure stated?

What is classed as high blood pressure?

Answer 8

BP = Systolic / Diastolic

Systolic - heart pumping

Diastolic - heart relaxing

High blood pressure classed as > 140/90

• or 150/90 for over 80 year olds

Question 9

What causes hypertension?

Answer 9

• usually primary (essential) - no single underlying cause but related to: obesity, smoking, alcohol, high salt diet, inactivity, genetic factors
• minority of patients - secondary hypertension: due to a disorder elsewhere in the body
  e. g. endocrine - hormone excess (cortisol, aldosterone)

or renal causes - polycystic kidneys, glomerular disease

Question 10

What are some red flags for hypertension:

Answer 10

• unless very high, hypertension is asymptomatic
• if very high can cause malignant hypertension (a medical emergency)
• worrying if sustained over 160/100 - can be fatal

Causes:

• encephalopathy
• retinal haemorrhages and papilloedema
• renal failure
• heart failure

Question 11

What is the medical management of hypertension?

Answer 11

Usually a combination of meds required to meet target <140/90

• ACE inhibitors e.g. ramipril
• Angiotensin II antoagonists e.g. valsartan
• Diuretics e.g. bendroflumethiazide
• Calcium channel blockers e.g. amlodipine
• Beta-blockers e.g. bisoprolol, atenolol

Question 12

What should you do with a patient presenting with hypertension?

Answer 12

• new referral to GP to rule out underlying causes and initiate treatment
• if untreated, postpone surgery requiring anaesthetic until under control
• give advice about lifestyle changes - lose weight, cut alcohol, low salt diet, take exercise

Question 13

How does Diabetes Mellitus affect CVD risk?

How does genetics affect risk of CVD?

Answer 13

Diabetes Mellitus

• Good control of blood sugar improves CV risk

Genetic Predisposition

• strong familial component
• can’t do anything apart from identify those most at risk from family history, calculate CV risk score and modify other risk factors

Question 14

What are the dental aspects of lifestyle advice?

Answer 14

• be positive, supportive and non-judgemental
• sign-post good sources of help
• accentuate positive benefits as well as highlighting risks

Question 15

List the diseases caused by atherosclerosis in different parts of the body:

Answer 15

• cerebrovascular disease (brain)
• ischaemic heart disease (heart)
• mesenteric ischaemia (gut)
• renovascular disease (kidney)
• abdominal aortic aneurysm (aorta)
• peripheral vascular disease (legs)