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CMS > Week 1 - Cardiovascular Disease I > Flashcards

Week 1 - Cardiovascular Disease I Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

what is the most important disease process in the developed world?

A

atherosclerosis

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2
Q

atherosclerosis can appear in which 4 diseases?

A
  1. ischaemic heart disease
  2. peripheral vascular disease
  3. cerebrovascular disease
  4. renovascular disease
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3
Q

atherosclerosis: describe the basic pathology and what 2 things the disease results from

A
  • accumulation of lipid rich plaques in arterial walls

disease results from:

  1. progressive narrowing; reduction of blood supply leading to ischaemia
  2. plaque rupture leading to thrombus formation and occlusion of blood supply -> infarction
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4
Q

what are the big 5 risk factors for atherosclerosis

A 
smoking
high cholesterol
high blood pressure
diabetes
genes
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5
Q

risk factors: smoking

what should healthcare workers advise on?

A
  • smoking prevention: dont start

- smoking management: advice, medication, acupuncture, hypnotism, group support

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6
Q

risk factors: smoking

what kind of medication can be given to patients to curb smoking?

A
  • nicotine replacements

- pharmacological: buproprion (zyban)

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7
Q

risk factors: high cholesterol
caused by?
ways of management?

A
  • lifestyle
  • genetic contribution: familial hypercholesterolaemia
  • dietary modifications
  • drugs: statins
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8
Q

risk factors: hypertension

  • BP stated as? describe each
  • what are the figures that represent high BP? how does this value change?
A
  • BP is the systolic / diastolic value
    systolic: heart pumping
    diastolic: heart relaxing
  • 160 / 90 is considered high BP
  • value can change if pt has existing heart disease
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9
Q

risk factors: hypertension
- usually primary or secondary? can be related to?
secondary hypertension: how often? what 2 factors cause it?

A
  • primary; no single underlying cause
  • but related to:
  • obesity, alcohol, high salt diet, genetics
  • secondary hypertension is the minority, where there is an underlying cause
    1. endocrine disease: hormonal excess
    2. renal disease: kidneys not functioning well
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10
Q

risk factors; hypertension
symptoms?
if very high, 240/130, what are the symptoms?

A
  • high BP is asymptomatic, unless extremely high
  • fits
    confusion
    headache
    breathlessness
    chest pain
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11
Q

risk factors: hypertension

management?

A
  • new referral to GP to rule out underlying causes and initiate treatment
  • if untreated, postpone surgery that require anaesthetic until under control
  • advice on lifestyle changes: lose weight, cut alcohol, low salt diet, exercise
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12
Q

risk factors: hypertension

what are the drugs used in management and their examples? x5

A
  • B-blockers: bisoprolol, atenolol
  • diuretics: bendroflumethiazide
  • ACE inhibitors: ramipril
  • angiotensin II antagonists: valsartan
  • calcium channel blockers: amlodipine
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13
Q

risk factors: diabetes

  • what is it
  • how to improve atherosclerosis risk
A
  • diabetes mellitus is elevated blood sugar

- control of blood sugar

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14
Q

risk factors: genetics

how to identify risk?

A
  • from family history, calculate risk with SCORE system

- modify other risk factors

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15
Q

other risk factors for atherosclerosis?

A

obesity
lack of exercise
diet: low cholesterol, avoid excess, five a day

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16
Q

atherosclerosis:
lifestyle changes?
factors to control in underlying disease process?

A
  • smoking cessation, avoidance
  • diet
  • exercise
  • high cholesterol, high BP, diabetes
17
Q

prevention: dental aspects

how should health professional give act while giving advice?

A
  • be positive, supportive and non-judgmental
  • sign post good sources of help
  • accentuate positive benefits as well as highlighting risks
18
Q

peripheral vascular disease: what is it

where does it occur

A
  • it is atherosclerosis affecting peripheral vessels

- lower limbs, abdominal aorta

19
Q

peripheral vascular disease:
chronic symptoms?
acute symptoms?

A
  • intermittent claudication: leg pain typically in calf occurring when walking a distance
  • ischaemic limb: pain at rest
    pale, cold, numb limb, no sensation cannot move
    is a medical emergency
20
Q

what is the claudication distance?

A

distance patient can cover before feeling pain

21
Q

peripheral vascular disease: management?

A
  • modify risk factors
  • exercise programme
  • surgery (bypass grafts, stents)
22
Q

peripheral vascular disease: abdominal aortic aneurysm

  • how does damage occur?
  • what is the great risk?
A
  • atherosclerosis leads to dilated aorta, which damages the vessel wall
  • risk of catastrophic rupture or tear
23
Q

abdominal aortic aneurysm: symptoms?

A
  • possibly nil
  • vague abdominal pain
  • acute pain with rupture: collapse, severe pain, high mortality
24
Q

ischaemic heart disease: clinical manifestations?

A
  • angina
  • acute coronary syndrome: heart attacks, unstable angina
  • heart failure
  • arrhythmias
25
Q

IHD: angina

  • what is it?
  • due to?
  • what causes the visceral pain?
  • where can pain be felt?
  • can be perceived as?
  • often related to?
A
  • angina is chest pain felt due to the restriction of blood supply to the heart
  • narrowing of coronary arteries
  • lack of blood (O2) to heart, ischaemia -> visceral pain
  • typically central chest, down left arm, atypical: jaw, back, upper abdomen
  • perceived as heaviness or breathlessness
  • related to effort, stress on heart
26
Q

IHD: unstable angina

  • signs of?
  • what to assess?
A
  • sign of developing heart attack
  • assess angina at rest,
    unpredictable onset,
    frequency increasing or amount of exertion reduced
27
Q

IHD: what kind of investigations can be done?

A
  • electrocardiogram (ECG)
  • exercise testing: ECG while heart under stress
  • thallium scan: can combine radiological investigation combined w exercise
28
Q 
IHD: investigations 
coronary angiography:
assess via?
what does it help to visualize?
can be combined with what at the same time?
how is coronary artery disease spotted?
A
  • access via radial or femoral arteries
  • visualizes blood vessels of the heart
  • can be combined with PCI: percutaneous coronary intervention. e.g. stents, balloon dilation
  • by a slight narrowing in the vessel
29
Q

IHD: management?

A
  • lifestyle modification
  • manage underlying medical condition (diabetes, HBP)
  • medical/drug treatment
  • surgical management
30
Q

IHD: management of stable angina?

A
  • anti-platelets: aspirin, clopidogrel
  • cholesterol: statins e.g. simvastatin
  • symptom relief:
    b-blockers: bisoprolol
    calcium antagonist: amlodipine
    nitrates: isosorbide mononitrate, GTN spray/tablets
    others: nicorandil
31
Q

IHD: surgical methods in management of stable angina?

A
  • coronary angioplasty

- coronary artery bypass grafting (CABG)

32
Q

IHD: acute coronary syndrome

- 2 associated conditions?

A
  • myocardial infarction

- unstable angina

33
Q

IHD: acute coronary syndrome: symptoms of heart attack?

A
  • crushing central chest pain
  • sweating, nausea, light headedness
  • feeling of imminent death or impending doom
  • cardiac arrest: sudden loss of consciousness
34
Q

IHD: acute coronary syndrome: symptoms of unstable angina?

A
  • at rest
  • unpredictable onset
  • increasing frequency to minimal exertion
  • cardiac arrest
35
Q

IHD: acute coronary syndrome: aims of hospitalization?

A
  • stabilize (oxygen, morphine, nitrates)
  • diagnose (ECG, troponin, angiography)
  • clear clot (thrombolysis, angioplasty)
36
Q

ischaemic heart disease: dental aspects

how to take a good history?

A
  • how often does pt use GTN spray?
  • how far can pt walk before requiring spray?
  • how many flights of stairs can pt climb before needing spray
  • any activities that give pt chest pain?
  • does pt get angina at rest

CMS (16 decks)

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