Ischaemic Heart Disease

Question 1

Primary prevention

Answer 1

focused on avoiding disease entirely. Interventions are done before a disease occurs to decrease the risk. This is done by: preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours an increasing resistance eg immunisation against infectious diseases, education about healthy and safe habits.

Question 2

Secondary prevention

Answer 2

involves screening the patient to offer early detection and diagnosis. This will allow for early treatment and a quicker return to baseline. This is done by detecting and treating disease as soon as possible, encouraging personal strategies to prevent reinjury or recurrence an implementing programs to return people to their original health and function to prevent long-term problems eg suitably modified work, diet or exercise programs.

Question 3

Primary prevention for CVD

Answer 3

• cessation of smoking
• Reduced alcohol intake
• Maintaining a healthy weight
• Exercising
• Following a healthy diet
• Improving sleep health
• Control of diabetes
• Control hypertension ( BP goal <130/80)

Question 4

Secondary prevention for CVD

Answer 4

• aspirin- 81/162 mg/day indefinitely
• statins
• b-blocker
• ACE inhibitor/ hypertension
• early diagnosis
• avoiding prolonged exposure to electromagnetic fields and regular visits to medical professionals could disrupt certain jobs or even regular life of the patient.

Question 5

COBRA-A mnemonic for secondary prevention in ACS

Answer 5

C – Clopidogrel – anti-platelet agent
• O – Omacar – Omega 3
• B – Bisoprolol – β-blocker
• R – Ramipril – ACE-i
• A – Aspirin
• A- Atorvastatin

Question 6

Qrisk 3 score

Answer 6

• tool to calculate the likelihood of having a stroke or heart attack in the next 10 years in people aged 25-84
• the recommended formal risk assessment tool to assess CVD risk for the primary prevention of CVD
• The higher the score, the greater the risk. Also, the more risk factors you have, the greater your risk.
• QRISK score will tell you whether you are at low, moderate or high risk of developing CVD in the next 10 years.

Question 7

Time period of qrisk 3 score

Answer 7

10 years

Question 8

Low qrisk score

Answer 8

QRISK3 score of less than 10%
• This means that you have less than a one in ten chance of having a stroke or heart attack in the next 10 years.

Question 9

Moderate qrisk score

Answer 9

QRISK3 of 10-20%
• This means that you have between a one to two in ten chance of having a stroke or heart attack in the next 10 ye

Question 10

High qrisk score

Answer 10

QRISK3 score of more than 20%
• This means that you have at least a two in ten chance of having a stroke of heart attack in the next 10 years

Question 11

Modifiable risk factors of ischaemic heart disease

Answer 11

• high blood pressure (hypertension)
• High levels of LDL/ low levels of HDL
• Hyperlipidemia
• Smoking
• Diabetes
• Being overweight
• Lack of physical activity
• Unhealthy diet
• Stress

Question 12

Non-modifiable risk factors for ischaemic heart disease

Answer 12

• male age- premenopausal women are very low risk- prevention / post menopausal women have a higher risk
• Increased levels of blood coagulation factor VII
• Ethnicity
• Family history
• Gender
• Low birth weight as at higher risk of adult obesity
• Socio-economic status- lower/middle social classes are at a greater risk than higher social classes

Question 13

Lifestyle advice to reduce risk of ischaemic heart disease

Answer 13

• Consuming a diet high in vegetables, fruits, and whole grains, including low-fat dairy, poultry, fish, legumes, and nontropical vegetable oils and nuts, while limiting sweets, sugar, sugar-sweetened beverages, and red meat.
• Consuming no more than 2400 mg of sodium per day.
• Engaging in aerobic physical activity 3 to 4 sessions per week lasting an average of 30 minutes per session of moderate to vigorous intensity physical activity.
• Quit smoking and moderate alcohol consumption

Question 14

Investigations for ischaemic heart disease

Answer 14

Heart rate and bp
ECG
Blood tests
Chest x-ray
CT scan
Echocardiogram
Stress tests
Coronary angiogram

Question 15

ECG

Answer 15

quick test to measure the electrical activity of the heart. Electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays or prints the test results. An ECG can show if the heart is beating too fast or too slowly. An ECG can help show if you have had or are having a heart attack.

Question 16

Blood tests

Answer 16

Certain heart proteins slowly leak into the blood after heart damage from a heart attack. The most common are: Full Blood count (FBC), Urea and Electrolytes (Us and Es) – urea levels help to monitor how the kidneys are working. Electrolytes help to stabilise the heart rhythm, Glucose, Liver and thyroid function, Troponin blood test – troponin is a protein which is released into the blood stream when the heart muscle is damaged. The troponin level provides a quick and accurate measure of any heart muscle damage. It’s used to help in the assessment following suspected heart attack. It may be taken on admission to hospital and/or 12 hours from the onset of symptoms, Cholesterol level and lipid profile, Natriuretic peptides – an indicator of heart failure.

Question 17

Chest x-ray

Answer 17

An X-ray of the chest shows the condition of the lungs and the size and shape of the heart and major blood vessels. A chest X-ray also can reveal lung problems such as pneumonia or a collapsed lung.

Question 18

CT scan

Answer 18

. CT scans can spot a blood clot in the lung or find an aortic dissection.

Question 19

Echocardiogram

Answer 19

Sound waves are used to create videos of the heart in motion. Sometimes, a more detailed echocardiogram may be done to get better pictures of the heart. A small device may be passed down the throat to obtain better views of different parts of the heart. Can check: size of heart, effectiveness of heart muscle contraction, effectiveness of valves

Question 20

Stress tests

Answer 20

These tests often involve walking on a treadmill or riding a stationary bike while the heart rhythm is watched. Exercise tests help show how the heart reacts to exercise. If you can’t exercise, you might be given medicines that affect the heart like exercise does.

Question 21

Coronary angiogram

Answer 21

This test helps health care providers see blockages in the heart arteries. A long, thin flexible tube is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the tube to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

Question 22

Basic metabolic panel

Answer 22

tests for levels of Blood urea nitrogen (BUN), Calcium, Carbon dioxide, Chloride, Creatinine, Electrolytes, Glucose, Potassium and Sodium
• Abnormal levels may indicate diabetes, hormone imbalances or kidney disease.

Question 23

Coagulation panel

Answer 23

measures how well blood clots and how long it takes to clot
• Results from a coagulation panel can be used to diagnose: Acute myeloid leukemia, Hemophilia (excessive bleeding), Liver conditions, Thrombosis, Vitamin K deficiency

Question 24

Full blood count

Answer 24

measures amount of red blood cells, white blood cells and platelets in blood

Question 25

Comprehensive metabolic panel

Answer 25

measure of health of kidneys and liver, monitors amount of glucose, fluids and electrolytes in the body
• can detect issues such as diabetes, heart disease and nutritional deficiencies

Question 26

C-reactive protein test

Answer 26

liver produces CRP when tissue in body are inflamed
• high CRP levels can indicate inflammation from a variety of causes, such as: Artery inflammation, Cancer, Heart disease, Infection, Inflammatory bowel disease (IBD), Lupus, Rheumatoid arthritis

Question 27

DHEA-sulfate serum test

Answer 27

DHEA hormone produced adrenal glands
• DHEA deficiency in men can be caused by: AIDS, Anorexia nervosa, Kidney disease, Type 2 diabetes
• High levels in women, and abnormally high levels in men, can be caused by: Abnormal genital development, Cancer or tumor in adrenal glands, Early-onset of puberty from congenital adrenal hyperplasia, Polycystic ovary syndrome (in women)

Question 28

Enzyme markers

Answer 28

test for CPK-1, CPK-2, CPK-3 and troponin
• high levels of CPK-1 can indicate brain injuries or cancer
• high levels of CPK-2 if suffered a heart attack
• high levels of CPK-3 results from muscle inflammation, injury or intense exercise
• Free a heart injury, the heart enzyme troponin can leak into blood

Question 29

Thyroid stimulating hormone test

Answer 29

• higher results = hypothyroidism
• Lower results = hyperthyroidism

Question 30

Challenges accessing healthcare

Answer 30

• the availability of services in their local area
• service opening times
• access to transport
• access to childcare
• language (spoken and written)
• literacy
• poor experiences in the past
• misinformation
• fear

Question 31

Lifestyle inequalities

Answer 31

• poor nutrition
• Higher rate of smoking
• Potentially more sedentary lifestyles
• social class differences in health damaging or health promoting behaviours such as dietary choices, consumption of drugs, alcohol and tobacco, active leisure time pursuits, and use of immunisation, contraception and antenatal services.
• Environmental risks such as poor housing conditions, work-based risks, pollutants, traffic danger. Poverty exposes people to health hazards. Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing
• Psychosocial: unsupportive family relationships, stressful life events. stressful social circumstances produce emotional responses which bring about biological changes that increase risk of heart disease. Psycho-social risk factors include social support, control and autonomy at work, the balance between home and work, and the balance between efforts and rewards.

Question 32

Life-course model

Answer 32

individuals who experienced poor home conditions in childhood are more likely to experience occupational disadvantage

Question 33

ACEs

Answer 33

impact of adverse childhood experiences on individuals’ risks of developing health harming behaviours in adult life. ACEs are stressful experiences occurring during childhood that directly harm a child (e.g. sexual or physical abuse) or affect the environment in which they live (e.g. growing up in a house with domestic violence).

Question 34

Health inequalities in most deprived areas

Answer 34

• have the highest prevalence of smoking, being physically inactive and being classified as obese or overweight
• often have a lower likelihood of starting cardiac rehab
• have lower hospital admissions rates for cardiovascular elective care and higher rates for emergency care.