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Cardiovascular Health > Unit 2: Screening & Detection > Flashcards

Unit 2: Screening & Detection Flashcards

1
Q

Define coronary heart disease, cerebrovascular disease, peripheral vascular disease.

A
  1. Coronary Heart Disease- disease of the blood vessels supplying the heart muscle
  2. Cerebrovascular Disease: disease of the blood vessels supplying the brain
  3. peripheral Vascular Disease: disease of the blood vessels supplying the arms and the legs
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2
Q

What is the underlying pathology of cardiovascular disease (CVD)?

A

Atherosclerosis, thrombus (clotting)

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3
Q

Name the non-modifable risk factors of atherosclerotic CV disease?

A

Non-modifiable

  1. Age i.e. >70
  2. Family history of CV disease (premature heart/CVD i.e. a fatal or non-fatal event (not an established diagnosis) in a 1st degree relative - parent or sibling which occur <65 yo (female) and <55 (male)- would indicate premature disease)
  3. Gender (male) - oestrogen withdrawal during menopause
  4. Inflammation
  5. Heredity (and ethnicity) - south asian, black Caribbean are some ethnicities that have a higher risk of CVD
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4
Q

Explain why one should quit smoking?

A

Smoking increases the risk of developing blood clots

  • 1 in every 2 smokers die of a tobacco related disease
  • Tobacco smoke contains over 4,000 chemicals, including tar, which cause cancer
  • Smoking can take 10-15 years off your life
  • Smokers are 60% more likely to die from heart disease than non smokers
  • Within 1 day of quitting - risk of heart attack begins to fall
  • Within 2 days - better sense of taste and smell
  • Within 3 days - feel less breathless
    After 15 years smoke-free your risk of sudden death from a heart attack is almost cut in half
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5
Q

How would you assess or measure smoking status?

How do you calculate pack years?

A

Self-reported
Breath carbon monoxide
Cotinine (analysis taken from urine or blood)

(no. of years smoked) x (no. of years) / 20 (as 20 cigarettes per pack) = pack-years

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6
Q

Can air pollution cause a heart attack and if so what types of air pollution?

A

Primary pollutants: nitric oxide (NO), carbon monoxide (CO), ammonia (NH3)

They increase plaque burden, damage endothelial walls causing inflammation

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7
Q

Name the modifiable medical risk factors of atherosclerotic CV disease?

A
  1. Hypertension
  2. Hyperglycaemia (Diabetes)
  3. Atherogenic dyslipdaemia (high blood cholesterol)
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8
Q

Name the modifiable lifestyle risk factors of atherosclerotic CV disease?

A
  1. Diet and nutrition (lifestyle)
  2. Physical inactivity
  3. Stress
  4. Smoking
  5. Alcohol
  6. Obesity/overweight
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9
Q

What is the blood pressure target for healthy people. What figure should it be under in average-aged adults?
In someone <69?
In someone >70?

A

120/80 mmHg
Everyone should be less than 140/90 mmHg - the lower the better once there are no symptoms of low blood pressure
120 - 130/80 mmHg
130-140/80 mmHg

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10
Q

What is the quantifiable method for diagnosing diabetes?

What is the fasting plasma glucose levels in normal (people diabetes), prediabetes and diabetes?

A

Measuring blood glucose levels

Normal: <5.5 mmol/l
Prediabetes: 5.5 - 6.9 mmol/l
Diabetes: > (or equal to) 7.0 mmol/l

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11
Q

What is the random blood glucose levels in normal and pre-diabetes?

What are the random blood glucose targets for adults with diabetes?

A

Normal or pre-diabetes: <11.1 mmol/l

Before meals: 4 - 7mmol/L
After meals: <9 mmol/L - type 1 diabetes
< 8.5 mmol/L - type 2 diabetes

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12
Q

How many categories of hypertension (HT) exist?

A

Grade 1 HT: 140-159 (and/or)/ 90-99 mmHg

Grade 2 HT: 160-179 (and/or)/ 100-109 mmHg

Grade 3 HT: >180 (and/or) / >110 mmHg

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13
Q

What is the blood pressure range for 18-69 year old adults who are being treated for high blood pressure?

A

Systolic blood pressure (SBP) of 120-130 mmHg

In all age categories of treated patients DBP should be <80mmHg

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14
Q

Outline how to take blood pressure accurately

A
  1. No talking
  2. Cuff has to be on BARE arm
  3. Support the arm at heart level
  4. Empty bladder first
  5. Support back
  6. Legs uncrossed
  7. Support feet
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15
Q
  1. What are the lipid targets for healthy people?

2. What are the lipid targets for people at low- moderate risk of CVD?

A
  1. LDL-C: <3 mmol/l
    Non-HDL: <4 mmol/l
    TG: <1.7 mmol/L
    HDL: >1 mmol/L (males), >1.2 mmol/L (females)
  2. LDL-C: <2.6 mmol/l
    Non-HDL: <3.4 mmol/l
    TG: <1.7 mmol/L
    HDL: >1 mmol/L (males), >1.2 mmol/L (females)
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16
Q

How do you calculate non-HDL cholesterol?

A

Total cholesterol - high cholesterol (HDL)

17
Q

What is the lipid targets for high risk people (with uncomplicated type 2 diabetes)?

A

LDL-C: < 1.8 mmol/l
Non-HDL: < 2.6 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L (males), > 1.2 mmol/L (female)

18
Q

What is the lipid targets for very high risk people (with diabetes/with CVD/target organ damage)?

A

LDL-C: < 1.4 mmol/l
Non-HDL: < 2.2 mmol/l
TG: <5 mmol/L
HDL: >1 mmol/L. (males), >1.2 mmol/L (females)

19
Q

What type of fats are healthiest?

What type of carbohydrate are healthiest?

A

Trans fatty acids are most linked to coronary heart disease (found in processed food, cakes, fries, anything with a long shelf-life). They should be replaced with mono unsaturated fatty acids and polyunsaturated fatty acids

Carbohydrates from refined starches/sugars should be replaced with carbohydrates from whole grains

20
Q

What range of waist circumference for healthy males and females?

A

Males: 94 - 102 cm
Females: 80 - 88cm

21
Q

What is the BMI for white European populations?

A

Underweight: <18.5 kg/m2

Increasing but acceptable risk: 18.5 - 24.9 kg/m2

Increased risk: 25 - 29.9 kg/m2

High risk: 30 kg/m2 or higher

22
Q

What is the BMI for Asian populations?

A

Underweight: < 18.5 kg/m2

Increasing but acceptable risk: 18.5 - 22.9 kg/m2

Increased risk: 23 - 27.5 kg/m2

High risk: 27.5 kg/m2 or higher

23
Q

How do you calculate BMI?

A

kg / (m)2

24
Q

Why is physical activity protective for the heart?

A

Anti-atherosclerotic: Decreases blood pressure, adiposity and inflammation
improves lipids & insulin sensitivity

Psychological: decreases depression and stress, increases social support

Anti-thrombotic: increases fibrinolysis
decreases platelet adhesiveness, fibrinogen and blood viscosity

Anti-ischaemic: decreases Myocardial O2 demand & endothelial dysfunction
increases coronary blood flow, endothelial progenitor cells (EPC’s), circulating angiogenic cells, nitric oxide

Anti-arrhythmic: increases vagal tone & heart rate decreases adrenergic activity

25
Q

What are psychosocial risk factors? (7)

A
  1. Social isolation
  2. Depression
  3. Anxiety
  4. Hostility
  5. Post-traumatic stress disorder
  6. Work and family stress
  7. Low socio-economic status
26
Q

What co-morbidities increase risk of developing CVD ? (11)

A
  1. Hypertension
  2. Diabetes mellitus
  3. Chronic kidney disease
  4. Dyslipidaemia
  5. Auto-immune conditions (e.g. Rheumatoid arthritis)
  6. Treated for cancer
  7. Influenza
  8. Serious mental health problems
  9. Periodontitis (a severe gum infection)
  10. HIV
  11. Infection
27
Q

Why is it important to screen for COPD and how does COPD increase the risk for CV death?

A

There is an inflammatory component to COPD and there is a hypoxia component - which leads to ischaemia -> arrhythmias - ischaemic heart disease

Any inflammatory condition increases cardiovascular death, myocardial infarction and heart failure eg ankylosing spondylitis and psoriatic arthritis

28
Q

How is erectile dysfunction the first indication of?

A

Erectile dysfunction is the first indication of atherosclerotic disease

29
Q

Explain the link between sleep and CV disease?

A

Sleep apnea is linked to increases in blood pressure, hypoxia
Insufficient sleep is linked to type 2 diabetes, CV disease, obesity and depression
Obstructive sleep apnea is a predictor of CV disease

30
Q

How would you estimate CVD risk?

A

The European Society of Cardiology SCORE (Systematic Coronary Risk Evaluation) tool is a popular choice in many European countries. Risk charts such as SCORE-2 are intended to estimate risk in apparently healthy individuals and are not intended for use among patients with established CVD as these patients are automatically considered high-risk and require intensive risk factor management (e.g. diabetes). SCORE predicts the likelihood of CVD events in the next 10-years

31
Q

How can patients figure out their risk of diabetes at home?

A

Using the diabetes risk calculator on riskscore.diabetes.org.uk
Checks your weight, height, waist measurement, blood pressure, familial diabetes

32
Q

What are the HbA1c targets for people without diabetes?

A

Without diabetes: <42 mmol/mol
Pre-diabetes: 42 - 47 mmol/mol
May indicate diabetes: >48 mmol/mol

33
Q

What are the HbA1c targets for people with diabetes?

A

48 - 58 mmol/mol

Ideally < 48 mmol/mol

Cardiovascular Health (9 decks)

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