Cardiovascular Disease Lecture 1

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.