Intro Flashcards
Area of system this disease affects, and name 4 diseases
Heart & circulation
CHD, AF, HF, Stroke
Describe the progression of cardiovascular disease
Risk factors, Arteriosclerosis, Coronary Artery Disease, Ischaemia, Plaque rupture + Thrombosis, Infarction, Loss of Contractility, Dilation and ‘Remodelling’, HF, end-stage HF
Risk factors (non-modifiable + unhealthy)
Non-modifiable: Age, Gender, Family history, Ethnicity
Unhealthy: Smoking, Physical inactivity, Diet high in fat, Psychosocial stress
First contact?
The NHS health check…
First contact: Opportunistic, Planned, Acute event
NHS Health check: Risk score BMI Blood pressure Cholesterol level Alcohol use score Smoking status Physical activity assessment results Diabetes risk assessment Heart age
Smoking cessation - treatment options
> 1-to-1 & group sessions
NRT
> Bupropion - reduces urge to smoke & symptoms of nicotine withdrawal
Varenicline - selective nicotine-receptor partial agonist
> E-cig
What is Hypertension
Too much pressure in blood vessels - damages blood vessels and increases cardiac workload
Prevalence influenced by age + lifestyle factors
It increases risk of stroke and heart disease
Treatment for Hypertension
> Aged under 55
> Aged over 55 or black person of African/ Caribbean family origin of any age
Lifestyle interventions for Hypertension
.Diet .Exercise .Relaxation therapy .Multiple interventions .Alcohol reduction .Salt reduction .other: Caffeine, smoking no effect on BP
What is atherosclerosis
A disease in which plaque builds up inside your arteries.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries.
What are SBP and DBP
How does this help to find the pulse pressure
Systolic pressure (top) is the maximum pressure your heart exerts while beating
Diastolic pressure (bottom) is the amount of pressure in your arteries between beats
Pulse pressure = difference between systolic and diastolic blood pressure
What do low and high pulse pressures indicate
Low (less than 40) may indicate poor heart function
Higher (greater than 60) may reflect leaky heart valves (valve regurgitation) often due to age-related losses in aortic elasticity
Most important cause of elevated pulse pressure is stiffness of the aorta (largest artery in body). The stiffness may be due to high bp or fatty deposits damaging the wall as of the arteries, leaving them less elastic (atherosclerosis). The greater pp, the stiffer and more damaged the vessels are thought to be.
Other conditions - inc severe iron deficiency (anaemia) and an overactive thyroid (hyperthyroidism) - can increase pp as well.
Treating high BP often reduces PP
What is the purpose of the Renin-Angiotensin-Aldosterone system
In response to low BP/ serum Na, RAAS system can kick in to help compensate.
So it helps to regulate BP, where low salt means low fluid and therefore a decrease in BP!
Impact of arteries becomes narrower?
Impact of Arterial embolism (when clot travels from the site where it formed to another location in the body)
Puts a strain on your heart bc it has to work harder to pump blood around your body.
Blood clots can block the artery completely.
Bits of these clots can break loose and become lodged in an artery/vein in another part of the body.
(In brain = stroke) (in heart = heart attack)
Treatment for Hyperlipidaemia (TC level > 5mmol/L)
Lifestyle advice: reduce saturated fats. Increase fish, fruit and vegs
Statins (eg: Atorvastatin, Simvastatin, Rosuvastatin)
> decreases TC level by 1mmol/l
Ezetimibe - monotherapy
> decreases TC level by 0.8mmol/l
Combination
> decreases TC level & LDL by 2mmol/l, increase HDL-C by 0.3
Other lipid lowering agents not recommended in primary prevention.
Mechanism of Action of Statins?
Mechanism of Action of Ezetimibe?
Statins: reduces cholesterol synthesis by inhibiting HMG-Co reductase
Ezetimibe: inhibits the intestinal absorption of intestinal luminal micelles (which contain cholesterol) at the brush border of the small intestine by selectively inhabiting the cholesterol transport NCP1L1
