W2 Introduction to CVD Flashcards
-Classification, Epidemiology and Risk
Cardiovascular ISU
What conditions are covered? (7)
- Hypertension
- Hyperlipidaemia
- Stroke
- Angina
- Acute myocardial infarction
- Chronic heart failure
- Arrhythmias
What is Cardiovascular disease? (CVD)
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
What are the Four main types of CVD?
- Coronary heart disease (CHD)
-Angina
-Myocardial infarction (MI)
-Heart failure - Strokes and transient ischaemic attacks (TIA)
- Peripheral arterial disease (PAD)
- Aortic disease- Most commonly: abdominal aortic aneurism (AAA)
How is Hypertension and Cardiovascular disease linked?
- Hypertension is a risk factor for CVD
- Around 50% of heart attacks and strokes are associated with high blood pressure in the UK
What are the major risk factors for developing CVD? (7)
Hypertension
Diabetes
High cholesterol
Smoking
Air pollution
Obesity/Overweight
Diet and Exercise
What are the minor risk factors for CVD?
(unchangeable) (5)
Impaired kidney function
old age
gender
family history
ethinicity
What is primary and secondary prevention?
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.
Morbidity Vs Mortality meaning?
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
Many CVD are ‘acquired’
What does this mean?
(for info)
- 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
A) What is risk stratification? (for info)
B) How can we do this?
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
What is Q-RISK?
Is it accurate?
- 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
What is included in primary prevention?
- 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
Secondary prevention measures can help prevent individuals from developing….
Coronary Heart Disease
What are the 3 lifestyle factors that can cause CVD?
- Smoking
- Obesity/Overweight
- Diet and exercise
What are the 3 medical risk factors that can cause CVD?
- Hypertension
- Diabetes
- Hyperlipidemia
Diabetes in treating CVD:
What should be targeted
- 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
HYPERLIPIDAEMIA in treating CVD:
who should lipid modification therapy be given to?
*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
What is CHD?
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.
What is ACS?
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
What is an ISCHAEMIC STROKE AND TIA?
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
What is Peripheral arterial disease? (PAD)
- 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
What is an Arrythmia?
- 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
What is a PCI?
Percutaneous coronary intervention
- formerly known as angioplasty with stent
What is a CABG? (for info)
Coronary Artery Bypass graft
- surgery that creates new path for blood to flow around a blocked or partially blocked artery in the heart
