W2 Introduction to CVD

Question 1

Cardiovascular ISU
What conditions are covered? (7)

Answer 1

• Hypertension
• Hyperlipidaemia
• Stroke
• Angina
• Acute myocardial infarction
• Chronic heart failure
• Arrhythmias

Question 2

What is Cardiovascular disease? (CVD)

Answer 2

Diseases of the circulation – heart and blood vessels

Includes:
Disorders of coagulation and also problems caused to other organs due to issues with blood supply

Question 3

What are the Four main types of CVD?

Answer 3

1. Coronary heart disease (CHD)
   -Angina
   -Myocardial infarction (MI)
   -Heart failure
2. Strokes and transient ischaemic attacks (TIA)
3. Peripheral arterial disease (PAD)
4. Aortic disease- Most commonly: abdominal aortic aneurism (AAA)

Question 4

How is Hypertension and Cardiovascular disease linked?

Answer 4

• Hypertension is a risk factor for CVD
• Around 50% of heart attacks and strokes are associated with high blood pressure in the UK

Question 5

What are the major risk factors for developing CVD? (7)

Answer 5

Hypertension
Diabetes
High cholesterol
Smoking
Air pollution
Obesity/Overweight
Diet and Exercise

Question 6

What are the minor risk factors for CVD?
(unchangeable) (5)

Answer 6

Impaired kidney function
old age
gender
family history
ethinicity

Question 7

What is primary and secondary prevention?

Answer 7

PRIMARY prevention strategies = identify and alter modifiable risks to reduce incidence in disease-free individuals or in the population.

SECONDARY prevention strategies= target individuals with established disease, who have usually had an ‘event’, to reduce morbidity and mortality.

Question 8

Morbidity Vs Mortality meaning?

Answer 8

The terms morbidity and mortality are often related but not identical. Morbidity is the state of being unhealthy for a particular disease or situation, whereas mortality is the number of deaths that occur in a population

Question 9

Many CVD are ‘acquired’
What does this mean?
(for info)

Answer 9

• This means, not ‘congenital’ (or inherited)
• Most events mostly due to lifestyle – and so are preventable
• Also influenced by non-modifiable risk factors – in reality, much is interconnected

Question 10

A) What is risk stratification? (for info)
B) How can we do this?

Answer 10

A) -Identifying potential patients requiring intervention for primary prevention relies on a strategy in primary care to stratify risk.
-Estimation of CVD risk should be done regularly for over-40s, using factors recorded in medical notes.
-A full, formal risk assessment should be carried out where a 10-year CVD risk is thought to be 10% or more.

B) Using tools such as Q-RISK reccomended by NICE
-Can only give an approximation of risk of developing a CVD
-Use this to target preventive medication and lifestyle modification
-A risk 10-year CVD risk of 10% or more is now classified as higher risk and more than 20% may require high-intensity therapy

Question 11

What is Q-RISK?
Is it accurate?

Answer 11

• An online risk calculator for CVD
  inc factors like age, ethnicity, smoking status, cholesterol:HDL ratio, Diabetes status, Postcode
• Can only give an approximation of risk of developing a CVD
  -Use this to target preventive medication and lifestyle modification
  -A risk 10-year CVD risk of 10% or more is now classified as higher risk and more than 20% may require high-intensity therapy

Question 12

What is included in primary prevention?

Answer 12

• Before offering medication - discuss the benefits of lifestyle modification and optimise the management of all other modifiable CVD risk factors
• People need support
• Incentivise people by repeating CVD

Question 13

Secondary prevention measures can help prevent individuals from developing….

Answer 13

Coronary Heart Disease

Question 14

What are the 3 lifestyle factors that can cause CVD?

Answer 14

1. Smoking
2. Obesity/Overweight
3. Diet and exercise

Question 15

What are the 3 medical risk factors that can cause CVD?

Answer 15

1. Hypertension
2. Diabetes
3. Hyperlipidemia

Question 16

Diabetes in treating CVD:

What should be targeted

Answer 16

• Helpful to regard type 2 diabetes as a cardiovascular disease as it carries such a high risk
• HbA1c should be treated to target with antidiabetic drugs BUT a full cardiovascular risk profile will be necessary and appropriate medicines should be used concurrently

hba1c= haemoglobin 1c

Question 17

HYPERLIPIDAEMIA in treating CVD:
who should lipid modification therapy be given to?

Answer 17

*Following formal risk assessment, give lipid modification therapy as primary prevention to:
-people aged 84 years and younger if their estimated 10-year risk of CVD using the QRISK assessment tool is 10% or more
-people with type 2 diabetes as above (higher dose in established CVD –secondary prevention)

Give lipid modification therapy, without risk assessment, as primary prevention to everyone with:
-type 1 diabetes, chronic kidney disease, familial hypercholesterolaemia and consider for everyone over 84

Question 18

What is CHD?

Answer 18

Coronary heart disease (CHD) is the most common type of CVD.
- It occurs when coronary arteries become narrowed by a build-up of atheroma.
- The pain or discomfort felt from such narrowing is angina and if a blockage occurs it can cause a myocardial infarction (MI).
- Individuals with CHD, or who have had an MI, are twice as likely to have a stroke as those who haven’t.

Question 19

What is ACS?

Answer 19

ACUTE CORONARY SYNDROME (ACS)
* ACS describes an ‘event’ in CHD - caused by a rupture or erosion of an atherosclerotic plaque and subsequent thrombus formation
-Unstable angina
-Non-ST-segment elevation MI (NSTEMI)
- ST-elevation MI (STEMI)
* Thrombus is primarily due to platelet aggregation under high stress
* Immediate treatment will often involve PCI or CABG
* Secondary prevention with antiplatelet therapy – aspirin, clopidogrel, ticagrelor, prasugrel

Question 20

What is an ISCHAEMIC STROKE AND TIA?

Answer 20

Most common type of stroke
-Usually caused due to a blockage where a small blood clot lodges in a vessel narrowed by an atheroma
-Blocks oxygenation of the affected part of the brain

-Secondary prevention with antiplatelets – clopidogrel or aspirin/dipyridamole combination

TIA= Transient ischemic attack

Question 21

What is Peripheral arterial disease? (PAD)

Answer 21

• Build-up of fatty deposits (atheroma) in the arteries restricts blood supply to leg muscles.
• Causing intermittent tiredness of leg due to restricted blood flow –”intermittent claudication”
• Secondary prevention with antiplatelets -aspirin

Question 22

What is an Arrythmia?

Answer 22

• An irregular heartbeat
• Treatment is required to control heart rate/rhythm to prevent cardiac arrest (pharmacological/surgical/etc.)
• Also, prophylactic medication required to prevent stroke as primary prevention
  -For example, in AF stagnation of blood in atria and incomplete ventricular emptying leads to clot formation, which can travel to the brain
  -Strokes caused by atrial fibrillation affect a larger part of the brain and are therefore more likely to be fatal or leave patients bedridden than non-cardioembolic strokes
  -Antiplatelets are less effective – need to anticoagulate

Question 23

What is a PCI?

Answer 23

Percutaneous coronary intervention
- formerly known as angioplasty with stent

Question 24

What is a CABG? (for info)

Answer 24

Coronary Artery Bypass graft
- surgery that creates new path for blood to flow around a blocked or partially blocked artery in the heart