Week 1 - Cardiovascular Disease I Flashcards
what is the most important disease process in the developed world?
atherosclerosis
atherosclerosis can appear in which 4 diseases?
- ischaemic heart disease
- peripheral vascular disease
- cerebrovascular disease
- renovascular disease
atherosclerosis: describe the basic pathology and what 2 things the disease results from
- accumulation of lipid rich plaques in arterial walls
disease results from:
- progressive narrowing; reduction of blood supply leading to ischaemia
- plaque rupture leading to thrombus formation and occlusion of blood supply -> infarction
what are the big 5 risk factors for atherosclerosis
smoking high cholesterol high blood pressure diabetes genes
risk factors: smoking
what should healthcare workers advise on?
- smoking prevention: dont start
- smoking management: advice, medication, acupuncture, hypnotism, group support
risk factors: smoking
what kind of medication can be given to patients to curb smoking?
- nicotine replacements
- pharmacological: buproprion (zyban)
risk factors: high cholesterol
caused by?
ways of management?
- lifestyle
- genetic contribution: familial hypercholesterolaemia
- dietary modifications
- drugs: statins
risk factors: hypertension
- BP stated as? describe each
- what are the figures that represent high BP? how does this value change?
- 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
risk factors: hypertension
- usually primary or secondary? can be related to?
secondary hypertension: how often? what 2 factors cause it?
- 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
risk factors; hypertension
symptoms?
if very high, 240/130, what are the symptoms?
- high BP is asymptomatic, unless extremely high
- fits
confusion
headache
breathlessness
chest pain
risk factors: hypertension
management?
- 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
risk factors: hypertension
what are the drugs used in management and their examples? x5
- B-blockers: bisoprolol, atenolol
- diuretics: bendroflumethiazide
- ACE inhibitors: ramipril
- angiotensin II antagonists: valsartan
- calcium channel blockers: amlodipine
risk factors: diabetes
- what is it
- how to improve atherosclerosis risk
- diabetes mellitus is elevated blood sugar
- control of blood sugar
risk factors: genetics
how to identify risk?
- from family history, calculate risk with SCORE system
- modify other risk factors
other risk factors for atherosclerosis?
obesity
lack of exercise
diet: low cholesterol, avoid excess, five a day
atherosclerosis:
lifestyle changes?
factors to control in underlying disease process?
- smoking cessation, avoidance
- diet
- exercise
- high cholesterol, high BP, diabetes
prevention: dental aspects
how should health professional give act while giving advice?
- be positive, supportive and non-judgmental
- sign post good sources of help
- accentuate positive benefits as well as highlighting risks
peripheral vascular disease: what is it
where does it occur
- it is atherosclerosis affecting peripheral vessels
- lower limbs, abdominal aorta
peripheral vascular disease:
chronic symptoms?
acute symptoms?
- 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
what is the claudication distance?
distance patient can cover before feeling pain
peripheral vascular disease: management?
- modify risk factors
- exercise programme
- surgery (bypass grafts, stents)
peripheral vascular disease: abdominal aortic aneurysm
- how does damage occur?
- what is the great risk?
- atherosclerosis leads to dilated aorta, which damages the vessel wall
- risk of catastrophic rupture or tear
abdominal aortic aneurysm: symptoms?
- possibly nil
- vague abdominal pain
- acute pain with rupture: collapse, severe pain, high mortality
ischaemic heart disease: clinical manifestations?
- angina
- acute coronary syndrome: heart attacks, unstable angina
- heart failure
- arrhythmias
IHD: angina
- what is it?
- due to?
- what causes the visceral pain?
- where can pain be felt?
- can be perceived as?
- often related to?
- 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
IHD: unstable angina
- signs of?
- what to assess?
- sign of developing heart attack
- assess angina at rest,
unpredictable onset,
frequency increasing or amount of exertion reduced
IHD: what kind of investigations can be done?
- electrocardiogram (ECG)
- exercise testing: ECG while heart under stress
- thallium scan: can combine radiological investigation combined w exercise
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?
- 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
IHD: management?
- lifestyle modification
- manage underlying medical condition (diabetes, HBP)
- medical/drug treatment
- surgical management
IHD: management of stable angina?
- 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
IHD: surgical methods in management of stable angina?
- coronary angioplasty
- coronary artery bypass grafting (CABG)
IHD: acute coronary syndrome
- 2 associated conditions?
- myocardial infarction
- unstable angina
IHD: acute coronary syndrome: symptoms of heart attack?
- crushing central chest pain
- sweating, nausea, light headedness
- feeling of imminent death or impending doom
- cardiac arrest: sudden loss of consciousness
IHD: acute coronary syndrome: symptoms of unstable angina?
- at rest
- unpredictable onset
- increasing frequency to minimal exertion
- cardiac arrest
IHD: acute coronary syndrome: aims of hospitalization?
- stabilize (oxygen, morphine, nitrates)
- diagnose (ECG, troponin, angiography)
- clear clot (thrombolysis, angioplasty)
ischaemic heart disease: dental aspects
how to take a good history?
- 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
