Lecture 15 - When the cardiovascular system goes wrong Flashcards by Damari Martin

Hypertension: what is it, how many people does it affect, and what may it cause and how?

High blood pressure

Affects 15 million people (28%) in the UK

May cause oedemas (increased filtration), strokes (artery cell damage: haemorrhage), CAD (stress and damage), aneurysms (wall stress - aneurysm), CKD (less blood - nephron damaged), and heart failures

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Hypertension: what are the risk factors?

Risk factors -
Primary hypertension = unknown medical cause:
* Overweight
* Eat too much salt and do not eat enough fruit and vegetables
* Do not do enough exercise
* Drink too much alcohol or coffee (or other caffeine-based drinks)
* Smoke
* Do not get much sleep or have disturbed sleep
* Are over 65

Secondary hypertension = known medical cause:
CKD, Pheochromocytoma (Adrenal Tumour), and endocrine disorder

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Hypertension: what are the treatments?

Decreasing blood volume and pressure -

Inhibiting RAAS:
* Angiotensin Converting Enzyme Inhibitor (ACEi)
* Angiotensin II Receptor Blocker (ARB)
* Aldosterone Antagonist (Spironalacton)

Calcium channel inhibitor

Thiazide diuretic (Inhibits renal Na+ reabsorption to increase water loss in urine)

The above treatments will be administered based on the severity (if one doesn’t do enough, two will be tried) but, if none of them works, further treatment is required

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Coronary artery/heart disease: what is it, how many people does it affect, and what may it cause and how?

Narrowing or blocking of the coronary arteries

190 million every year

Chest pain, shortness of breath or even a heart attack due to the heart receiving insufficient nutrients, oxygen, and blood

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Coronary artery/heart disease: what are the risk factors?

Build of plaque in the coronary arteries caused by:

Endothelial damage (high BP, smoking, diabetes, obesity)
High LDL cholesterol and triglyceride levels

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Coronary artery/heart disease: what are the treatments?

Cholesterol drugs
Aspirin
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)
Nitroglycerin
Ranolazine

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Aneurysms: what is it, how many people does it affect, and what may it cause and how?

Bulge in a blood vessel caused by a weakness in the blood vessel wall

Up to 500,000

An aneurysm can burst (rupture), causing internal bleeding and leading to death, they are usually asymptomatic, so, even if it’s large, an aneurysm may go unnoticed

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Aneurysms: what are the risk factors?

Endothelial damage (high BP, smoking, diabetes, obesity)

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Aneurysms: what are the treatments?

If preventative treatment is recommended, the main techniques used are called neurosurgical clipping and endovascular coiling. Both techniques help prevent ruptures by stopping the blood from flowing into the aneurysm.

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Chronic kidney disease: what is it, how many people does it affect, and what may it cause and how?

Long-term condition where the kidneys don’t operate as they should

Up to 800,000 million suffer from the condition

Nephrons in kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.

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Chronic kidney disease: what are the risk factors?

Hypertension, diabetes, being of black or south Asian descent

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Chronic kidney disease: what are the treatments?

No real cure, lifestyle changes only

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Stroke: what is it, how many people does it affect, and what may it cause and how?

Life-threatening medical condition that happens when the blood supply to part of the brain is cut off

More than 110,000 have experienced it

Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination

Can eventually lead to irreparable death in certain brain cells

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Stroke: what are the risk factors?

Blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn’t cause a lasting symptom

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Stroke: what are the treatments?

injections of a medicine called alteplase, which dissolves blood clots and restores blood flow to the brain and various other clot dismantlers

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Arrhythmias: what is it, how many people does it affect, and what may it cause and how?

A deviation of the heart’s normal sinus rhythm

Many millions can experience it to various extremities so the number may reach 450 million

Symptoms can range between:
* Asymptomatic
* Palpitations
* Fainting
* Heart failure
* Additional ventricular depolarisations (long QT syndrome) leading to Ventricular tachycardia
* Early depolarisations causing premature concentrations (VT) -> Ventricular fibrillation
* Strokes caused by quivering atria (AF)
* Cardiac arrest & death caused by quivering ventricles (not pumping): VF

Arrhythmias: what are the risk factors?

Viral illnesses, alcohol, tobacco, changes in posture, exercise, drinks containing caffeine, certain over-the-counter and prescribed medicines, and illegal recreational drugs

Arrhythmias: what are the treatments?

Pacemaker/defibrillator

Myocardial infarction: what is it, how many people does it affect, and what may it cause and how?

Heart attack happens when one or more areas of the heart muscle don’t get enough oxygen

More than 3 million a year

Blood is not pumped to the rest of the body in sufficient amounts which may lead to the death of certain cells/tissues/organs

Myocardial infarction: what are the risk factors?

Coronary artery/heart disease is the main cause

Myocardial infarction: what are the treatments?

Aspirin, clopidogrel, heparin, or other anticlotting agents to prevent new clots as well as defibrillators and CPR

Thrombosis: what is it, how many people does it affect, and what may it cause and how?

Blood clots in the veins

Up 10 million each year

Pain and swelling in one leg, chest pain, or numbness on one side of the body, may even cause a heart attack or stroke

Thrombosis: what are the risk factors?

Injury to a vein, such as from surgery, a broken bone, or other trauma

Thrombosis: what are the treatments?

Anti-coagulants, anti-platelet therapy (aspirin)

Heart failure: what is it, how many people does it affect, and what may it cause and how?

When cardiac output is inadequate to meet the body’s demands 20-64 million every year Blood often backs up and causes fluid to build up in the lungs (congest) and in the legs. The fluid buildup can cause shortness of breath and swelling of the legs and feet. Poor blood flow may cause the skin to appear blue (cyanotic)

Heart failure: what are the risk factors?

High blood pressure (puts extra strain on the heart, which can lead to heart failure) which can be caused by hypertension, conditions affecting the heart muscle (cardiomyopathy) heart rhythm problems (arrhythmias), such as atrial fibrillation. damage or other problems with the heart valves

Heart failure: what are the treatments?

β-adrenoceptor antagonists, reducing SNS activity to reduce workload and prevent desensitization Other medications may be used but if they are not enough, then left ventricle assists or heart transplants may be used; however, these may have rejection issues so these are not ideal

Valvular disease: what is it, how many people does it affect, and what may it cause and how?

When the valves in the heart are suffering from some disease 9 million During systole: valves fail to open properly and the afterload is increased, reducing ejection During diastole: valves fail to close properly, resulting in the backflow of blood and reduced Stoke Volume & Cardiac Output After a significant amount of time, it leads to LV hypertrophy and eventually failure

Valvular disease: what are the risk factors?

Congenital conditions (being born with it), infections (rheumatic fever is a common cause, with symptoms appearing years after infection), degenerative conditions (wearing out with age), and conditions linked to other types of heart disease

Valvular disease: what are the treatments?

Surgery

Atherosclerosis: what is it, how many people does it affect, and what may it cause and how?

The build-up of plaque (atheroma) in blood vessels 50% chance for 40-year-olds and above but still possible to get while younger but the risk increases with age Can cause arteries to narrow, blocking blood flow, and leading to coronary heart disease. The plaque can also burst, causing venous thromboembolism (blood clot)

Atherosclerosis: what are the risk factors

Endothelial damage (high BP, smoking, diabetes, obesity) High LDL cholesterol and triglyceride levels

Atherosclerosis: what are the treatments?

Lifestyle changes, such as eating a healthy diet and exercising, may be all that is needed to treat atherosclerosis but sometimes, medication or surgical procedures may be needed Medication: Statins and other cholesterol drugs, Aspirin, Blood pressure medications, etc