Lecture 15 - When the cardiovascular system goes wrong

Question 1

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

Answer 1

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

Question 2

Hypertension: what are the risk factors?

Answer 2

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

Question 3

Hypertension: what are the treatments?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

Build of plaque in the coronary arteries caused by:

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

Question 6

Coronary artery/heart disease: what are the treatments?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

Aneurysms: what are the risk factors?

Answer 8

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

Question 9

Aneurysms: what are the treatments?

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

Chronic kidney disease: what are the risk factors?

Answer 11

Hypertension, diabetes, being of black or south Asian descent

Question 12

Chronic kidney disease: what are the treatments?

Answer 12

No real cure, lifestyle changes only

Question 13

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

Answer 13

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

Question 14

Stroke: what are the risk factors?

Answer 14

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

Question 15

Stroke: what are the treatments?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

Arrhythmias: what are the risk factors?

Answer 17

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

Question 18

Arrhythmias: what are the treatments?

Answer 18

Pacemaker/defibrillator

Question 19

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

Answer 19

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

Question 20

Myocardial infarction: what are the risk factors?

Answer 20

Coronary artery/heart disease is the main cause

Question 21

Myocardial infarction: what are the treatments?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

Thrombosis: what are the risk factors?

Answer 23

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

Question 24

Thrombosis: what are the treatments?

Answer 24

Anti-coagulants, anti-platelet therapy (aspirin)

Question 25

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

Answer 25

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)

Question 26

Heart failure: what are the risk factors?

Answer 26

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

Question 27

Heart failure: what are the treatments?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

Valvular disease: what are the risk factors?

Answer 29

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

Question 30

Valvular disease: what are the treatments?

Answer 30

Surgery

Question 31

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

Answer 31

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)

Question 32

Atherosclerosis: what are the risk factors

Answer 32

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

High LDL cholesterol and triglyceride levels

Question 33

Atherosclerosis: what are the treatments?

Answer 33

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