Cardiovascular Disease (CVD)

• Cardiovascular disease (CVD) refers to a group of disorders affecting the heart and blood vessels.

UK Statistics

• 7.6 million people live with CVD.
• 450 CVD-related deaths occur daily.
• There are 100,000 annual hospital admissions due to heart attacks.
• A stroke happens every 5 minutes.
• The annual healthcare cost for CVD is £9 billion.

Types of Cardiovascular Disease

• Coronary heart disease
• Cerebrovascular disease
• Peripheral vascular disease
• Deep vein thrombosis and pulmonary embolism
• Valvular heart disease
• Congenital heart disease

Lifestyle Risk Factors for CVD

• Unhealthy diet, especially high in salt
• Physical inactivity
• Obesity
• Smoking
• Alcohol consumption

Other Risk Factors for CVD

• Hypertension
• High cholesterol
• Diabetes
• Kidney disease
• Age
• Gender
• Ethnicity
• Family history

Atherosclerosis

• Common disorder underlying CVD involving plaques (atheroma).
• This results in the narrowing of arteries.
• The narrowing limits oxygen-rich blood flow to organs.
• Subtle chemical or physical damage to the artery's endothelium triggers a chronic inflammatory response.

Stages of Atherosclerosis

• Endothelial injury or dysfunction
• Fatty streak: Lipids accumulate beneath the damaged endothelium
• Inflammatory response: White blood cells and foam cell formation is recruited
• Plaque progression: Migration of smooth muscle cells plus connective tissue, calcification, platelet adhesion, and fibrous cap formation increase
• Plaque disruption

Risk Factors for Atherosclerosis

• Physical stress on arteries
• Turbulent flow (e.g., at artery branch points)
• Smoking/air pollution leads to reactive oxygen radicals
• Dyslipidaemia: High total cholesterol, high LDLs, low HDLs
• Chronically elevated blood glucose levels

Complications of Atherosclerosis

• Thrombosis: Complete blockage of the artery
• Infarction: Impaired blood flow leading to tissue death
• Embolus: A clot that travels and can block a coronary artery or an artery to the brain
• May result in Ischaemic heart disease, Angina, Myocardial infarction (heart attack), Cerebrovascular disease (stroke), Aneurysm, Peripheral vascular disease

Ischaemic Heart Disease

• Ischaemia involves the restriction of blood supply to tissues
• It is due to atherosclerosis and hypertension
• Can lead to angina pectoris and myocardial infarction
• Infarction results in the acute failure of the body's circulation, loss of cerebral blood supply, and death
• Risk factors include age, smoking, hyperlipidaemia, diabetes, and hypertension

Hyperlipidaemia

• It presents as high blood cholesterol.
• It can be familial.
• Associated factors are age, gender, inactivity, being overweight, low dietary fibre, smoking, ethnicity, low socioeconomic status, and other diseases (hypertension, diabetes, chronic kidney disease)
• Management includes lowering LDL and raising HDL levels via lifestyle modifications.
• Statins are a treatment.

Angina Pectoris

• It is severe chest pain caused by narrowed coronary arteries.
• Myocardial ischaemia is linked to increased blood lactic acid.
• Pain results in Squeezing, crushing, gripping substernal sensations (may radiate to left arm/jaw)
• It can be stable or unstable.

Angina Pectoris Management

• Relief comes from rest or glyceryl trinitrate (GTN) medication.
• The glyceryl trinitrate (GTN) medicatiion stimulates vasodilation.
• Typically, pain resolves in 2-3 minutes
• Additional medications are aspirin, calcium channel blockers, beta blockers, ACE inhibitors, and statins
• Angioplasty or surgery is used to place stents or perform a coronary artery bypass graft

Myocardial Infarction

• Also known as a heart attack or coronary thrombosis.
• It involves sudden injury due to blockage of a coronary artery.
• Rupture of a vulnerable atheromatous plaque occurs.
• This results in ischaemia (oxygen shortage).
• Ischaemia leads to necrosis (tissue death) of the myocardium

Myocardial Infarction Clinical Presentation

• Severe, central crushing pain that radiates to the left arm or jaw
• May start at rest and persists
• Restlessness, facial pallor, sweating, nausea, vomiting, confusion, and apprehension
• 10-20% of patients may not experience pain (silent infarctions)
• Women presenting with atypical symptoms
• can results Death soon after the onset of chest pain from ventricular fibrillation and cardiac arrest

Myocardial Infarction Management

• Call emergency services
• Position patient comfortably
• Administer GTN spray if for known angina
• Have the patient chew dispersible aspirin 300mg (unless allergy evidence is present).
• Give oxygen if the patient is hypoxaemic
• Monitor and prepare to initiate CPR/AED
• Immediate hospital admission for ECG, blood tests, echocardiogram, Oxygen, Thrombolytic therapy, Analgesics, Anticoagulants, ACE inhibitors, Sedative, Bed rest, Surgery

Myocardial Infarction Complications

• Outlook can depend on onset to treatment.
• Acute outcomes can be cardiac dysrhythmias, cardiac failure and pericarditis.
• Later outcomes are angina, thromboembolism, aneurysm, and cardiac rupture
• Long term - post Ml syndrome (also called Dressler’s syndrome), shoulder-hand syndrome, psychological problems and depression

Cardiac Arrest

• Also known as cardiopulmonary arrest.
• It represents an abrupt loss of heart function, breathing, and consciousness
• It results from Electrical malfunction which stops heart beating and oxygen-rich blood is prevented from reaching the brain, lungs and other organs
• It may occur after a myocardial infarction.

Cardiac Arrest Management

• Survival possibility decrease with the amount of time arrested
• Chain of survival concept
• CPR provides circulatory support
• Use of AED if a shockable rhythm is present (ventricular fibrillation or pulseless ventricular tachycardia)

Cardiac Devices

• Implantable cardiac loop recorders
• Pacemakers
• Implantable cardioverter defibrillator

Pacemakers

• Medical devices replace or regulate the heart's electrical conduction.
• Electrodes deliver electrical impulses and cause the heart muscle to contract, pumping blood.

Cerebrovascular Disease

• Affects the blood vessels of the brain and the cerebral circulation
• Causes: Stenosis, thrombosis, embolism, and haemorrhage
• Includes cerebrovascular accident (stroke) and transient ischaemic attacks (TIAs

Stroke and TIA

• Rapid onset and brain infarction
• Ischaemic stroke is caused by embolism from a distant site or thrombosis of a cerebral vessel
• Haemorrahgic is caused by an intracerebral or subarachnoid bleed
• Transient ischaemic attack (TIA) is a 'mini stroke' that lasts 24hrs
• 1 in 8 people die within 30 days of having a stroke