Introduction for Cardiovascular Disease

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  • Created by: LBCW0502
  • Created on: 17-01-19 09:53
What is CVD?
Umbrella term that describes all diseases of the heart and circulation e.g. coronary heart disease, atrial fibrillation, heart failure, and stroke. 7 million in UK with CVD, 80% with CVD have 1+ health condition (diseases not isolated)
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Which factors are a burden of disease?
Tobacco smoking, high BP, high BMI, physical inactivity/low physical activity, alcohol use, diet low in fruits, high total cholesterol
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Outline the progression of CVD
Risk factors, arteriosclerosis, coronary heart disease, ischaemia, plaque rupture and thrombosis, infarction, low contractility, dilatation and remodelling, heart failure, end-stage heart failure
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What is infarction?
When the cardiac muscle is damaged
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Give examples of non-modifiable risk factors (1)
Age, gender (risk factors for men and women are equal after women go through menopause), family history (male, 1st degree relative with CVD incident ~ 55 years, female, 1st degree relative with CVD incident after menopause)
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Give examples of non-modifiable risk factors (2)
Ethnicity (e.g. Asians have smaller coronary arteries)
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Give examples of unhealthy lifestyle choices
Cigarette smoking, physical inactivity, diet in high fat, psychosocial stress
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Give examples of high risk diseases
Hypertension, diabetes, hyperlipidaemia, obesity
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Give examples of end organ damage
Heart disease, stroke, peripheral artery disease, chronic kidney disease
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Outline the effect of risk factors on heart disease
Exponential effect on risk of heart attack e.g. smoker – 3 times more likely to get an MI compared to healthy person of the same age (graph/diagram)
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Describe features of first contact
Opportunistic (individual awareness, family pressure). Planned (NHS health checks, pharmacy/GP/other, Well man clinical/GP/private). Acute event
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What are the issues between male patients and first contact?
Considered ‘well’ until you experience MI. Difficulty in getting males into modifying lifestyle until something happens (difficult to get first contact)
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Describe features of the NHS health check (1)
Risks scores in the next 10 years, low (<10% chance of MI), moderate (10-20% chance of MI), high (>20% chance of MI) – no significance to individual patient
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Describe features of the NHS health check (2)
Check: BMI, BP, cholesterol level, alcohol use score, smoking status, physical activity assessment result, diabetes risk assessment, heart age
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What is the QRISK calculator?
Gives a % of how likely a patient will get an MI in the next 10 years (based on health Qs) - important to interpret/explain to patient
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Give examples of what would be in an action plan (patient case)
Quit smoking, control BP, reduce serum cholesterol, reduce weight, moderate alcohol use, increase physical activity
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Describe the issues with smoking
Kills over 120,000 people in UK annually (biggest single cause of preventable and early death in the UK). Costs NHS £1.7 bn (biggest single cause of inequalities in health). Difficult for patients to stop smoking
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What are the smoking cessation treatment options? (1)
One to one/group stop smoking sessions, nicotine replacement therapy (side effects - GI, nausea, vomiting, dry mouth etc.). Bupropion (Zyban), reduces urge to smoke/symptoms of nicotine withdrawal (CI - epilepsy, anorexia, liver cirrhosis, pregnancy)
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What are the smoking cessation treatment options? (2)
(caution - low seizure threshold, alcohol misuse etc.), side effects include dry mouth, headache, insomnia. Varenicline (Champix) - selective nicotine-receptor partial agonists (caution - mental illness, side effect - nausea)
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What are the smoking cessation treatment options? (3)
(reduce dose in renal impairment). Use of e-cigarettes. Effective to have combination of treatments and support (graph)
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Describe features of hypertension
Too much pressure in blood vessels (damages blood vessels and increases cardiac workload). Influenced by age/lifestyle factors. Increases risk of stroke/heart disease. Many patients diagnosed/not treated/treated properly
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Outline the treatment for hypertension
<55 years (ACE inhibitor for angiotensin receptor blocker, calcium channel blocker, diuretic). Calcium channel blocker needed for patients >55 yrs or Black/Caribbean origin
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Give examples of lifestyle interventions
Diet (healthy, low calorie), exercise (aerobic), relaxation therapy (structured), multiple interventions, alcohol reduction, salt reduction, other (reduce caffeine intake)
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Describe features of ACE inhibitors
Vasodilation by preventing conversion of Ang 1 to Ang 2. Reduces BP. Side effects (persistent dry cough, hyperkalaemia, worsening renal failure, angiodema/causes anaphylaxis, hypotension, electrolyte imbalance (e.g. ramipril, enalapril, lisinopril)
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Describe features of angiotensin receptor blockers
Directly block AT2 receptor on blood vessels causing vasodilation. Reduces BP. Side effects - hyperkalaemia, worsening renal failure, angiodema, hypotension, electrolyte imbalance (e.g. losartan, candesartan)
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Describe features of calcium channel blockers
Vasodilation by preventing calcium influx into smooth muscle cells. Reduces BP. Side effects - flushing, headache, dizziness, ankle swelling (e.g. dihydropyridines, amlodipine, felodipine)
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Describe features of diuretics
Stop resorption of sodium (more urine produced). Reduces BP. Side effects - constipation/hyperkalaemia/hypotronaemia, electrolyte imbalance, headache, postural hypotension, hyperuricaemia (e.g. thiazides, bendroflumethiazide, indapamide)
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What are the 4th line drugs used under specialised supervision?
Loop diuretics (e.g. furosemide, bumetanide), alpha blockers (e.g. doxazosin), beta blockers (e.g. bisoprolol, atenolol)
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Outline the Renin-Angiotensin-Aldosterone System
Renin - Angiotensin I - ACE - Angiotensin II (vasoconstrictor). Renin - Aldosterone - Na/H2O retention (see diagram)
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What is arteriosclerosis?
Cholesterol build up on arteriole walls, unable to carry oxygen efficiently. Too much cholesterol causing atheromatous plaques making arteries stiffer/narrower
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What is the effect of narrowed arteries on the heart?
Puts a strain on the heart because it has to work harder to pump blood around the body
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What is the effect of blood clots in blood vessels?
Can block the artery completely, cutting off the blood flow. Bits of blood clots can break away and become lodged in an artery or vein in another part of the body, which can cause a heart attack or stroke
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Describe features of hyperlipidaemia treatment (1)
Lifestyle advice (reduce saturated fats, increase fish, fruit/veg).
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Describe features of hyperlipidaemia treatment e.g. atorvastatin, simvastatin, rosuvastatin (2)
Statins - reduce cholesterol synthesis by inhibiting HMG-Co reductase, decreases TC cholesterol and increases HDL-C, side effects - nasopharyngitis, headache, constipation, flatulence, dyspepsia, nausea, and diarrhoea, myalgia, arthralgia
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Describe features of hyperlipidaemia treatment e.g. ezetimibe (3)
Monotherapy only if statin CI or not tolerated/or in combination if target not reached. Inhibits intestinal absorption of intestinal luminal micelles which contain cholesterol at brush border of SI, selectively inhibits cholesterol transport NPC1L1
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Describe features of hyperlipidaemia treatment e.g. ezetimibe (4)
Decreases TC/LDL cholesterol, increases HDL-C. Side effects - asthenia, diarrhoea, GI discomfort. Also combination treatments (other lipid lowering agents are not recommended in primary prevention
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Describe the mechanism of action for statins (1)
Inhibit HMG-CoA reductase, leading to decreases cholesterol concentration in cell. Low intracellular cholesterol stimulates synthesis of LDL receptors. Increased number of LDL receptors promotes uptake of LDL from blood
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Describe the mechanism of action for statins (2)
Low intracellular cholesterol decreases secretion of VLDL
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Describe the mechanism of action for ezetimibe
Inhibits intestinal absorption of intestinal luminal micelles which contain cholesterol at brush border of SI, selectively inhibits cholesterol transport NPC1L1 (diagrams)
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Describe features of Well Man Clinics (1)
Health checks vary between clinics but the following are assessed: lifestyle (diet, exercise, alcohol, smoking), medical history, weight/height, BP, cholesterol, hearing/vision, lung function, urine test (diabetes/kidney function)
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Describe features of Well Man Clinics (2)
ECG to check heart problems, chest X-ray (if you're a heavy smoker)
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Other cards in this set

Card 2

Front

Which factors are a burden of disease?

Back

Tobacco smoking, high BP, high BMI, physical inactivity/low physical activity, alcohol use, diet low in fruits, high total cholesterol

Card 3

Front

Outline the progression of CVD

Back

Preview of the front of card 3

Card 4

Front

What is infarction?

Back

Preview of the front of card 4

Card 5

Front

Give examples of non-modifiable risk factors (1)

Back

Preview of the front of card 5
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