Cardiovascular conditions

Question 1

Cardiovascular disease

Answer 1

General term for conditions affecting the heart or blood vessels.
Usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and an increased risk of blood clots.

One of the main causes of death and disability in the UK, but it can often largely be prevented by leading a healthy lifestyle.

4 main types of CVD:
– coronary heart disease, stroke and TIA’s, peripheral artery disease, aortic disease

• coronary heart disease:
  – occurs when the flow of oxygen-rich blood to the heart muscle is blocked or reduced.
  – can lead to:
  —- angina pectoris, heart attacks and heart failure
• stroke and TIA’s (transient ischaemic attack):
  – where the blood supply to part of the brain is cut off, which can cause brain damage and possible death
• face, arms, speech, time
• peripheral arterial disease:
  – occurs when there is a blockage in the arteries to the limbs, usually the legs.
  – this can cause:
  —- dull or cramping in legs
  —- hair loss on legs and feet
  —- numbness or weakness in the legs
  —- persistent ulcers on the feet and legs
• aortic disease:
  – group of conditions affecting the aorta
  – most common is aortic aneurysm, which usually doesn’t give off symptoms but can burst and be potentially life threatening

Causes:
- exact cause unclear but there is risk factors that can increase the likelihood:
— high blood pressure, smoking, diabetes, inactivity, being overweight or obese, family history of CVD

Symptoms:
– angina pectoris
– shortness of breath (dyspnea)
– dizziness or fainting
– fatigue or exhaustion

Question 2

Cardiac causes of chest pain

Answer 2

Can be both ischemic and nonischemic

Ischemic- angina pectoris, myocardial infarction, aortic stenosis and coronary vasospasm

Nonischemic- pericarditis, aortic dissection and mitral valve prolapse

Angina pectoris:
- chest pain caused by restricted blood flow to the heart muscle.

• cause:
  – usually caused by atherosclerotic changes within the arteries supplying blood to the heart meaning they become narrowed and allow less blood through.
  – things that can increase the likelihood of atherosclerosis:
  —- an unhealthy diet
  —- a lack of exercise
  —- smoking
  —- increasing age
  —- a family history of atherosclerosis or heart problems
• population affected:
  – prevalence increases with age in both sexes
• risk factors:
  – hypertension, hyperlipidaemia, diabetes mellitus, sedentary lifestyle, obesity, smoking and family history
• clinical presentation:
  – classically felt as an ache or discomfort in the centre of the chest
  – patients may describe a tight or crushing sensation
  – may be associated with pain or paraesthesia in 1 or both arms
  – may radiate to jaw and face pain
  – lasts for up to 10 minutes
• triggers:
  —- exertion
  —- emotion
  —- cold windy weather
  —- unaffected by twisting, inspiration or turning

Different diagnosis’s of angina:
– classic angina- typically tends to occur with exercise or emotional stress, easily rapidly with rest
– stable angina (more common)- attacks have a trigger (stress or exercise) stop when rest
– unstable angina (less common)- attacks are more unpredictable (may not have a trigger) can continue despite rest. (may be developed after stable angina has been developed)

Myocardial infarction:
Definition:
– otherwise known as a heart attack, a serious medical emergency, where the blood supply to the heart is suddenly blocked, usually by a blood clot.

cause:
– leading cause is coronary heart disease (condition in which the major blood vessels that supply the heart get clogged with deposits of cholesterol (atherosclerosis)
—- before a heart attack, one of the plaques ruptures, causing a blood clot to develop. this clot may block the blood supply to the heart, causing a heart attack

risk factors:
– age- M-45 W-55
– smoking
– high blood pressure
– high cholesterol
– diabetes
– obesity
– sedentary lifestyle
– poor diet
– stress
– drugs
– autoimmune disease like RA or lupus

Clinical presentation:
– symptoms can occur in the days or even weeks preceding the event:
– fatigue
– chest discomfort
– malaise (generally feeling of discomfort or illness)

– typical chest pain in acute MI has the following characteristics:
—- intense and unremitting for 30-60 minutes
—- substernal, and often radiates up the neck, shoulder, and jaw, and down the left arm
—- usually described as a substernal pressure sensation that also may be characterised as squeezing, aching, burning or even sharp
—- in some patients the symptom is epigastric, with a feeling of indigestion or of fullness and gas

• patients HR may be tachycardia
• pulse may be irregular
• blood pressure elevated
• respiratory rate increased

prognosis:
- time it takes to recover depends on the amount of damage to your heart muscle that has taken place.
- most people can return to work after they have suffered a heart attack

Pericarditis:
definition:
– swelling and irritation of the thin, sacklike tissue surrounding the heart (pericardium)
– the chest pain occurs when the irritated layers of the pericardium rub against each other

cause:
- viral infection
- myocardial infarction
- surgery
- radiotherapy

clinical presentation:
- sharp anterior central chest pain
- inspiration, swallowing and posture can make it worse
- cough
- fatigue or general feeling of weakness or being sick
- leg swelling
- low-grade fever
- pounding or racing heartbeat (heart palpitation)
- shortness of breath when lying down
- swelling of the belly (abdomen)

prognosis:
- usually mild and goes away without any treatment
- treatment for more severe cases may include medications, and, rarely surgery

aortic dissection:
definition:
- tear in the intima of the thoracic aorta, blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). if the blood goes through the outside aortic wall, aortic dissection is often deadly

cause:
- caused by the weakening of an area of the aortic wall.
- divided into 2 types depending on which part of the aorta has been affected:
—- type A- more common and more dangerous. Tear in the aorta where it exits the heart. May also occur in the upper aorta (ascending aorta) which may extend into the abdomen.
—- Type B- tear in lower aorta (descending aorta), which may extend into the abdomen

Risk factors:
- hypertension
- atherosclerosis of arteries
- aortic valve defect
- narrowing of the aorta at birth

clinical presentation:
- abrupt very severe tearing chest pain, often in the mid scapular area
- may cause MI or syncope (fainting or passing out)
- shortness of breath
- weak pulse in one arm or thigh compared with the other
- leg pain
- difficulty walking
- loss of consciousness