Cardiovascular Disease

Question 1

What is cardiovascular disease?

Answer 1

Question 2

Briefly explain the following:

1. Coronary heart disease
2. Cerebrovascular disease
3. Peripheral arterial disease
4. Deep vein thrombosis and pulmonary embolism
5. Rheumatic heart disease
6. Congenital heart disease

Answer 2

1. disease of the blood vessels supplying the heart muscle
2. disease of the blood vessels supplying the brain
3. disease of blood vessels supplying the arms andlegs
4. blood clots in the leg veins, which can dislodge and move to the heart and lungs.
5. damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
6. malformations of heart structure existing at birth

Question 3

Define blood pressure

Answer 3

the force exerted on the arterial walls by the blood circulating through them

Question 4

Finish these two equations:

Blood Pressure = _______ _______ x ______ _________

Cardiac Output = _____ ______ x ______ ________

Answer 4

Blood Pressure = Cardiac Output x Peripheral Resistance

Cardiac Output = Heart Rate x Stroke Volume

Question 5

How is blood pressure controlled?

(4 ways)

Answer 5

• Nervous control
  
  • Cardiovascular Centre in Medulla
• Hormonal Regulation
  
  • Adrenaline/Noradrenaline
  • Antidiuretic hormone
  • Angiotensin II
  • Aldosterone
• Chemical mediators
  
  • oxygen and carbon dioxide
  • vasoactive substances from cells
• Auto regulation (local control)
  
  • physical factors
  • warmth vasodilation
  • cold vasoconstriction

Question 6

Outline the pathophysiology of hypertension

Answer 6

Persistently elevated arterial BP

• Sustained increase in peripheral resistance and Increased circulating blood volume or both.
• Several mechanisms proposed for primary ↑BP
• Increased sympathetic drive
• Activation of Renin-aldosterone-angiotensin system

Question 7

Define, and give causes for…

1. Essential hypertension
2. Secondary hypertension
3. Malignant

Answer 7

1. The blood pressure is elevated without evidence of other disease causing elevation.
   
   1. Thought to include constitutional factors involving the kidney, SNS hyperactivity, renin angiotension system, or interacelluar sodium levels.(Porth, 2011).
2. The blood pressure is raised as a result of some other disorder
   
   1. Renal problems; Drugs; Hormonal; Tumor; Coarctation of Aorta
3. Small no. with hypertension develop accelerated form. Diastolic values above 120mmHg; Uncontrollable & Severe; Rapidly progressive; Serious complications

Question 8

Define the three stages of hypertension

Answer 8

Question 9

How is high blood pressure diagnosed?

Answer 9

Question 10

What are the signs and symptoms of high blood pressure?

Answer 10

Can be asymptomatic in early stages

Fatigue

Malaise

Headache

Question 11

List some complications of high blood pressure

Answer 11

Major risk factor for atherosclerosis

Peripheral vascular disease

Aortic aneurysm / Aortic dissection

Heart failure/ Acute coronary syndromes

Renal damage

Stroke

Ophthalmic damage.

Question 12

Outline the management of hypertension

Answer 12

1. Lifestyle interventions – Patient will need assessment, education & ongoing support.
2. Cardiovascular risk management.
3. Pharmacological Interventions
   
   1. Under 55 years - angiotensin-converting enzyme (ACE) Inhibitor
   2. > 55 years calcium-channel blocker (CCB)
   3. Diuretic treatment
   4. Beta-blockers may be considered in younger people

Question 13

What is the relationship between hypertension and cardiovascular disease?

Answer 13

Question 14

What is arteriosclerosis?

Answer 14

General term for all types of arterial changes, characterised by thickening & hardening of vessel wall.

Best applied to degenerative changes in the small arteries & arterioles in over 50’s & those with diabetes.

Accumulation of plasma proteins & lipids

Causes loss of elasticity, thickening & hardening of walls, narrowed lumen & obstruction

Leading to ischemia and necrosis such as brain, kidneys, heart.

Question 15

What is atherosclerosis?

Answer 15

A form of Arteriosclerosis, accumulation of lipid-laden macrophages within arterial wall.

• Leading to the presence of Atherosclerotic / atheromatous plaque.
• Pathological process affecting vascular systems throughout the body.
• Results in ischaemic conditions that can vary in severity & clinical manifestations.
• Disease of large and medium sized arteries.

Question 16

Describe the features of atherosclerosis

Answer 16

• Progressive disease, begins with injury to endothelial cells, adhesion of monocytes & platelets.
• Inflammation of endothelial cells, initiates the process of atherogenesis.
• Impairs ability to make antithrombotic & vasodilating cytokines.
• Inflamed endothelial cells cause binding of macrophages, inflammatory & immune cells.
• Resulting in activation of macrophages, releasing numerous inflammatory mediators & enzymes. Damages vessel wall.
• These adhere to endothelium & penetrate the intimia, macrophages engulf lipoproteins (LDL Particles).
• Lipid laden macrophages now called foam cells.
• Significant amount = fatty streaks.
  
  • Fatty streaks – produce more toxic oxygen free radicals, secrete additional inflammatory mediators. Causing progressive damage to vessel wall.
• Macrophages release growth factor that stimulates smooth muscle cell proliferation.
  
  • cause further proliferation, producing collagen, migrating over the fatty streak, forming a fibrous plaque (atheroma /fibrous cap).
• Plaque = an accumulation of lipids, proliferation of SMC, scar tissue & calcification.
  
  • Plaques can be unstable
  • Prone to rupture, ruptured plaques (Complicated lesions)

Question 17

What are the clinical manifestations of atherosclerosis?

Answer 17

Narrowing of blood vessels causing ischaemia.

• Abdominal Aorta /Iliac Arteries
• Coronary Arteries
• Thoracic Aorta, Femoral & popiteal arteries
• Internal carotid Arteries
• Vertebral, basiliar and middle cerebral arteries

Sudden vessel obstruction

Thrombosis & emboli formation

Aneurysm formation.

Question 18

Define the term ‘stroke’

Answer 18

Also known as a cerebrovascular accident, it is any focal neurological deficit of vascular origin which is either fatal or lasts longer than 24 hours.

Question 19

A stroke results in injury of brain tissue

What effects will the interruption of cerebral blood supply have?

Answer 19

• O2 and glucose supply reduced
• Oedema at site of stroke
• Interruption of cerebral blood supply

Question 20

What are the two main types of stroke?

Answer 20

Occlusive/Ischaemic (most common)

Haemorrhagic (bleeding into brain tissue)

Question 21

Briefly outline the pathophysilogy of a stroke

Answer 21

• Infarction of brain tissue
• Tissue necrosis
• Central area of tissue necrosis develops
• Surrounded by an area of inflammation
• Immediate loss of function.

Question 22

Patient AS suffers a stroke

1) Name some likely clinical manifestations
2) What is a simple way to assess a stroke?

Answer 22

1) Depends on the cerebral artery affected and the area of brain tissue supplied by that vessel

• loss of consciousness
• motor or sensory impairment
• hemiparesis
• Numbness, weakness or paralysis on one side of the body
• Slurred speech or difficulty finding words or understanding speech
• Sudden blurred vision or loss of sight
• Confusion
• Severe headache

2) FAST – (face, arm, speech, time)

Question 23

Compare and contrast an ischaemic and haemorrhagic stroke

Answer 23

Question 24

Outline the pharamocological management of a stroke and any important considerations to make

Answer 24

• Thrombolysis
• Aspirin
• Anti-hypertensive
• Lipid lowering drugs

Question 25

What are the risk factors for a stroke?

Answer 25

* Age (risk increases with age) * Hypertension * Heart disease/Arrhythmia * Smoking * Hyperlipademia * Diabetes * Polycythemia

Question 26

What is a Transient Ischaemic Attack

Answer 26

Temporary localised reduction in blood flow in the brain. Can be caused by partial occlusion Recovery within 24 hours. Can serve as a warning. Person remains conscious.

Question 27

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