Cardiovascular Disease Lecture 1

Study Notes

Cardiovascular Disease Lecture 1

Cardiovascular disease (CVD) is a range of conditions affecting the heart and/or blood vessels. It's caused by blood clots (thrombosis) or atherosclerosis.
Atherosclerosis involves fatty deposits (plaques) building up in arteries, hardening them and narrowing the passage for blood.
Atherosclerosis leads to several conditions: coronary heart disease (angina, myocardial infarction), stroke, transient ischemic attack (TIA), and peripheral arterial disease.
CVD is a leading cause of morbidity and mortality. Approximately one in three deaths are related to CVD.
The annual cost to the NHS for CVD exceeds £29 billion.
Regional variations exist in CVD death rates. Rates vary across regions in England and Wales, influenced by lifestyle factors, healthcare access, and standards of living. There's a significant regional disparity—the north has lower life expectancy and higher CVD rates than southern regions.
Life expectancy has fallen in some northern regions of England over the last two decades.
Modifiable risk factors for CVD include smoking, low HDL cholesterol, high non-HDL cholesterol, sedentary lifestyle, unhealthy diet, excessive alcohol, obesity.
Non-modifiable risk factors include age (increasing risk with age), gender (males generally at higher risk), family history of CVD, ethnicity.
Comorbidities that increase CVD risk include hypertension, diabetes, chronic kidney disease, dyslipidaemia (inherited or drug-induced), atrial fibrillation, rheumatoid arthritis, Systemic Lupus Erythematosus (SLE), influenza, and severe mental health issues (anxiety is a risk factor).
The Health Check Programme is available in the UK for those aged 40-74 who haven't yet been diagnosed with CVD, diabetes, or chronic kidney disease. Checks include a CVD risk assessment, alcohol assessment, physical activity evaluation, cholesterol level, BMI, dementia screening (for 65-74 year olds), and diabetes/chronic kidney disease screenings for those at risk.

Aortic Valve Stenosis

Aortic valve stenosis involves narrowing, stiffening, and thickening of the aortic valve (often due to calcification).
Normal aortic valve area is 3.5-4 cm². A significantly smaller area (<0.8 cm²) is critical.
Symptoms generally occur later in the disease course with poor life expectancy (2 to 5 years if untreated) when they appear.
Symptoms include chest pain (angina), fatigue, syncope (fainting), and congestive heart failure.
Risk factors: older age, congenital heart disease, rheumatic heart infection, degenerative calcification, prior radiation to the heart, chronic kidney disease (CKD).
Associated with CVD risk factors: diabetes, high cholesterol, high blood pressure, obesity.

Cardiomyopathies

Cardiomyopathies are diseases of the heart muscle. They can be hereditary or acquired.
Three main types: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC).
Hypertrophic cardiomyopathy (HCM): inherited, heart muscle wall thickens abnormally.
Dilated cardiomyopathy (DCM): heart muscle stretches and thins, causing poor pumping.
Arrhythmogenic right ventricular cardiomyopathy (ARVC): genetic, right side of the heart muscle deteriorates, causing irregular heartbeats.
Takotsubo cardiomyopathy is caused by stress and is temporary.

Heart Failure

Heart failure occurs when the heart isn't pumping blood effectively.
Several causes: obesity, chronic kidney disease (CKD), sleep apnea, poorly managed hypertension, ischemia due to coronary artery disease, myocardial infarction, valvular heart disease, myocarditis, congenital abnormalities, familial cardiomyopathies.
Possible electrical defects can cause insufficient blood ejection.