Week 1 - Cardiovascular Disease I

Question 1

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

Answer 1

atherosclerosis

Question 2

atherosclerosis can appear in which 4 diseases?

Answer 2

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

Question 3

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

Answer 3

• 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

Question 4

what are the big 5 risk factors for atherosclerosis

Answer 4

smoking
high cholesterol
high blood pressure
diabetes
genes

Question 5

risk factors: smoking

what should healthcare workers advise on?

Answer 5

• smoking prevention: dont start

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

Question 6

risk factors: smoking

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

Answer 6

• nicotine replacements

- pharmacological: buproprion (zyban)

Question 7

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

Answer 7

• lifestyle
• genetic contribution: familial hypercholesterolaemia
• dietary modifications
• drugs: statins

Question 8

risk factors: hypertension

• BP stated as? describe each
• what are the figures that represent high BP? how does this value change?

Answer 8

• 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

Question 9

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

Answer 9

• 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

Question 10

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

Answer 10

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

Question 11

risk factors: hypertension

management?

Answer 11

• 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

Question 12

risk factors: hypertension

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

Answer 12

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

Question 13

risk factors: diabetes

• what is it
• how to improve atherosclerosis risk

Answer 13

• diabetes mellitus is elevated blood sugar

- control of blood sugar

Question 14

risk factors: genetics

how to identify risk?

Answer 14

• from family history, calculate risk with SCORE system

- modify other risk factors

Question 15

other risk factors for atherosclerosis?

Answer 15

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

Question 16

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

Answer 16

• smoking cessation, avoidance
• diet
• exercise
• high cholesterol, high BP, diabetes

Question 17

prevention: dental aspects

how should health professional give act while giving advice?

Answer 17

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

Question 18

peripheral vascular disease: what is it

where does it occur

Answer 18

• it is atherosclerosis affecting peripheral vessels

- lower limbs, abdominal aorta

Question 19

peripheral vascular disease:
chronic symptoms?
acute symptoms?

Answer 19

• 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

Question 20

what is the claudication distance?

Answer 20

distance patient can cover before feeling pain

Question 21

peripheral vascular disease: management?

Answer 21

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

Question 22

peripheral vascular disease: abdominal aortic aneurysm

• how does damage occur?
• what is the great risk?

Answer 22

• atherosclerosis leads to dilated aorta, which damages the vessel wall
• risk of catastrophic rupture or tear

Question 23

abdominal aortic aneurysm: symptoms?

Answer 23

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

Question 24

ischaemic heart disease: clinical manifestations?

Answer 24

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

Question 25

IHD: angina - what is it? - due to? - what causes the visceral pain? - where can pain be felt? - can be perceived as? - often related to?

Answer 25

- 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

Question 26

IHD: unstable angina - signs of? - what to assess?

Answer 26

- sign of developing heart attack - assess angina at rest, unpredictable onset, frequency increasing or amount of exertion reduced

Question 27

IHD: what kind of investigations can be done?

Answer 27

- electrocardiogram (ECG) - exercise testing: ECG while heart under stress - thallium scan: can combine radiological investigation combined w exercise

Question 28

``` 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? ```

Answer 28

- 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

Question 29

IHD: management?

Answer 29

- lifestyle modification - manage underlying medical condition (diabetes, HBP) - medical/drug treatment - surgical management

Question 30

IHD: management of stable angina?

Answer 30

- 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

Question 31

IHD: surgical methods in management of stable angina?

Answer 31

- coronary angioplasty | - coronary artery bypass grafting (CABG)

Question 32

IHD: acute coronary syndrome | - 2 associated conditions?

Answer 32

- myocardial infarction | - unstable angina

Question 33

IHD: acute coronary syndrome: symptoms of heart attack?

Answer 33

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

Question 34

IHD: acute coronary syndrome: symptoms of unstable angina?

Answer 34

- at rest - unpredictable onset - increasing frequency to minimal exertion - cardiac arrest

Question 35

IHD: acute coronary syndrome: aims of hospitalization?

Answer 35

- stabilize (oxygen, morphine, nitrates) - diagnose (ECG, troponin, angiography) - clear clot (thrombolysis, angioplasty)

Question 36

ischaemic heart disease: dental aspects | how to take a good history?

Answer 36

- 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