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Questions and Answers
Which of the following is a lifestyle risk factor for cardiovascular disease?
Which of the following is a lifestyle risk factor for cardiovascular disease?
What stage of atherosclerosis is characterized by the accumulation of lipids beneath the damaged endothelium?
What stage of atherosclerosis is characterized by the accumulation of lipids beneath the damaged endothelium?
Which of the following conditions may result from myocardial infarction?
Which of the following conditions may result from myocardial infarction?
What is the primary cause of ischaemic heart disease?
What is the primary cause of ischaemic heart disease?
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Which of the following medications is used to relieve angina pectoris?
Which of the following medications is used to relieve angina pectoris?
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Which factor is NOT associated with hyperlipidaemia?
Which factor is NOT associated with hyperlipidaemia?
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What risk factor can contribute to the development of atherosclerosis?
What risk factor can contribute to the development of atherosclerosis?
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Which symptom is commonly associated with myocardial infarction?
Which symptom is commonly associated with myocardial infarction?
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What physiological change occurs in the arteries during the early stage of atherosclerosis?
What physiological change occurs in the arteries during the early stage of atherosclerosis?
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Which of the following is a consequence of plaque disruption in atherosclerosis?
Which of the following is a consequence of plaque disruption in atherosclerosis?
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Which type of cardiovascular disease primarily affects the heart's coronary arteries?
Which type of cardiovascular disease primarily affects the heart's coronary arteries?
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What is the significance of a total annual healthcare cost of £9 billion related to cardiovascular disease in the UK?
What is the significance of a total annual healthcare cost of £9 billion related to cardiovascular disease in the UK?
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What is the primary focus of understanding different types of cardiovascular disease for patient management?
What is the primary focus of understanding different types of cardiovascular disease for patient management?
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Which of the following conditions falls under the umbrella of cerebrovascular disease?
Which of the following conditions falls under the umbrella of cerebrovascular disease?
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What lifestyle factor is closely associated with increasing the risk of cardiovascular disease?
What lifestyle factor is closely associated with increasing the risk of cardiovascular disease?
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What percentage of healthcare is attributed to cardiovascular disease based on the statistics provided?
What percentage of healthcare is attributed to cardiovascular disease based on the statistics provided?
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What is the most likely cause of deep vein thrombosis?
What is the most likely cause of deep vein thrombosis?
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Which part of patient management is essential when dealing with patients with congenital heart disease?
Which part of patient management is essential when dealing with patients with congenital heart disease?
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What role does systemic disease play in relation to oral health?
What role does systemic disease play in relation to oral health?
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How many deaths daily in the UK are attributed to cardiovascular disease?
How many deaths daily in the UK are attributed to cardiovascular disease?
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What is a common symptom of a myocardial infarction?
What is a common symptom of a myocardial infarction?
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Which factor could indicate a silent myocardial infarction?
Which factor could indicate a silent myocardial infarction?
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What is the initial management step for suspected myocardial infarction?
What is the initial management step for suspected myocardial infarction?
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Which of the following is a potential complication following a myocardial infarction?
Which of the following is a potential complication following a myocardial infarction?
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What should be administered to a patient experiencing a myocardial infarction unless contraindicated?
What should be administered to a patient experiencing a myocardial infarction unless contraindicated?
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What does cerebral hypoxia during cardiac arrest lead to?
What does cerebral hypoxia during cardiac arrest lead to?
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What is the chain of survival's first step when managing cardiac arrest?
What is the chain of survival's first step when managing cardiac arrest?
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What symptom may women experience during a myocardial infarction that differs from typical presentations?
What symptom may women experience during a myocardial infarction that differs from typical presentations?
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Which of the following is NOT a possible long-term complication of myocardial infarction?
Which of the following is NOT a possible long-term complication of myocardial infarction?
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What should be done if an AED indicates a shockable rhythm during cardiac arrest?
What should be done if an AED indicates a shockable rhythm during cardiac arrest?
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Which of the following conditions is a result of blockage of arteries supplying the brain?
Which of the following conditions is a result of blockage of arteries supplying the brain?
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What describes the process of smooth muscle cell migration and calcification in atherosclerosis?
What describes the process of smooth muscle cell migration and calcification in atherosclerosis?
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In which type of heart disease are the valves either damaged or dysfunctional?
In which type of heart disease are the valves either damaged or dysfunctional?
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What is the primary cause of myocardial infarction?
What is the primary cause of myocardial infarction?
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Which risk factor is associated with increased plaque formation due to high cholesterol levels?
Which risk factor is associated with increased plaque formation due to high cholesterol levels?
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What condition involves chest pain triggered by narrowing of the coronary arteries?
What condition involves chest pain triggered by narrowing of the coronary arteries?
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What type of cardiovascular disease affects blood vessels outside of the heart and brain?
What type of cardiovascular disease affects blood vessels outside of the heart and brain?
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Which of the following is a key complication resulting from plaque disruption in atherosclerosis?
Which of the following is a key complication resulting from plaque disruption in atherosclerosis?
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What is a characteristic feature of stable angina?
What is a characteristic feature of stable angina?
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Which process begins with endothelial injury in arteries?
Which process begins with endothelial injury in arteries?
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What is the main characteristic of primary hypertension?
What is the main characteristic of primary hypertension?
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What is a common complication of chronic hypertension?
What is a common complication of chronic hypertension?
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What lifestyle factor directly contributes to increased risk of cardiovascular disease?
What lifestyle factor directly contributes to increased risk of cardiovascular disease?
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Which type of stroke is caused by a blood vessel rupture?
Which type of stroke is caused by a blood vessel rupture?
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What is the primary management step for a suspected myocardial infarction?
What is the primary management step for a suspected myocardial infarction?
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Which of the following indicates a silent myocardial infarction?
Which of the following indicates a silent myocardial infarction?
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What symptom would raise suspicion of a stroke?
What symptom would raise suspicion of a stroke?
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What is a critical condition that can occur due to cardiac arrest?
What is a critical condition that can occur due to cardiac arrest?
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What is a common factor leading to peripheral vascular disease?
What is a common factor leading to peripheral vascular disease?
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What should healthcare professionals consider when treating cardiovascular patients?
What should healthcare professionals consider when treating cardiovascular patients?
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Study Notes
Cardiovascular Disease
- Cardiovascular disease (CVD) is a group of disorders affecting the heart and blood vessels.
- In the UK, 7.6 million people live with CVD, with 450 deaths daily and 100,000 hospital admissions annually due to heart attacks.
- Every 5 minutes, 1 person experiences a stroke.
- The annual healthcare cost of CVD in the UK 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
Risk Factors for Cardiovascular Disease
-
Lifestyle factors:
- Unhealthy diet (high in salt)
- Physical inactivity
- Obesity
- Smoking
- Alcohol
-
Other factors:
- Hypertension
- High cholesterol
- Diabetes
- Kidney disease
- Age
- Gender
- Ethnicity
- Family history
Atherosclerosis
- A common disorder underlying CVD.
- Characterised by narrowing of arteries due to the build-up of plaques (atheroma).
- Restricts oxygen-rich blood flow to organs.
- Triggered by endothelial damage, initiating a chronic inflammatory response.
Stages of Atherosclerosis
- Endothelial injury or dysfunction: Initial damage to the inner lining of the artery.
- Fatty streak: Lipids accumulate beneath the damaged endothelium.
- Inflammatory response: White blood cells are recruited, leading to foam cell formation.
- Plaque progression: Smooth muscle cells migrate, connective tissue increases, calcification occurs, platelets adhere, and a fibrous cap forms.
- Plaque disruption: The plaque can rupture, triggering a blood clot.
Atherosclerosis - Risk Factors
- Physical stress on arteries: Turbulent blood flow, especially where arteries branch.
- Smoking/air pollution: Circulation of reactive oxygen radicals.
- Dyslipidaemia: High total cholesterol, high LDLs, low HDLs.
- Chronically elevated blood glucose levels.
Atherosclerosis - Complications
- Thrombosis: Complete blockage of the artery by a blood clot.
- Infarction: Impaired blood flow leads to tissue death.
- Embolus: A blood clot that travels to a coronary artery or artery supplying the brain.
- Ischaemic heart disease, Angina, Myocardial infarction (heart attack), Cerebrovascular disease (stroke), Aneurysm, Peripheral vascular disease
Ischaemic Heart Disease
- Ischaemia: Restriction of blood supply to tissues.
- Ischaemic (coronary) heart disease: Caused by atherosclerosis and hypertension.
- Leads to angina pectoris and myocardial infarction.
- Infarction can cause acute circulatory failure, loss of cerebral blood supply, and death.
- Risk factors: Age, smoking, hyperlipidaemia, diabetes, hypertension.
Hyperlipidaemia
- High blood cholesterol, potentially familial.
- Associated with: Age, gender, inactivity, being overweight, low dietary fibre, smoking, ethnicity, low socioeconomic status, and other diseases (hypertension, diabetes, chronic kidney disease).
- Management focuses on lowering LDL levels and raising HDL levels through lifestyle modifications and, if necessary, statins.
Angina Pectoris
- Severe chest pain caused by narrowed coronary arteries.
- Myocardial ischaemia leads to increased blood lactic acid.
- Associated with squeezing, crushing, gripping substernal pain (may radiate to the left arm or jaw).
- Can be stable or unstable.
Angina Pectoris - Management
- Relieved by rest or glyceryl trinitrate (GTN) medication.
- GTN stimulates vasodilation, resolving pain in 2-3 minutes.
- Other medications may be required: Aspirin, calcium channel blockers, beta blockers, ACE inhibitors, statins.
- Angioplasty or surgery to place stents or perform a coronary artery bypass graft may be necessary.
Myocardial Infarction
- Heart attack or coronary thrombosis.
- Sudden injury caused by blockage of a coronary artery.
- Rupture of a vulnerable atheromatous plaque.
- Ischaemia leads to necrosis (tissue death) of the myocardium.
Myocardial Infarction - Clinical Presentation
- Severe, central crushing pain radiating to the left arm or jaw.
- May start at rest and persist.
- Restlessness, facial pallor, sweating, nausea, vomiting, confusion, and apprehension.
- 10-20% of patients experience no pain (silent infarctions).
- Women may present with atypical symptoms.
- Death can occur soon after the onset of chest pain due to ventricular fibrillation and cardiac arrest.
Myocardial Infarction - Management
-
Immediate hospital admission for:
- Comfortable position
- GTN spray (if known angina)
- Dispersible aspirin 300mg chewed (unless clear evidence of allergy)
- Oxygen (if patient hypoxaemic)
- ECG, blood tests, echocardiogram
- Thrombolytic therapy
- Analgesics
- Anticoagulants
- ACE inhibitors
- Sedative
- Bed rest
- Surgery
Myocardial Infarction - Complications
- Outlook depends on the time between onset and treatment.
- Acute complications: Cardiac dysrhythmias, cardiac failure, and pericarditis.
- Later complications: Angina, thromboembolism, aneurysm, cardiac rupture.
- Longer-term complications: Post-MI syndrome (Dressler’s syndrome), shoulder-hand syndrome, psychological problems, and depression.
Cardiac Arrest - Consequences
- Cardiac arrest is a serious event.
- Cerebral hypoxia causes respiratory arrest and brain injury.
- Survivors may experience personality changes, memory and speech impairment, involuntary movements, and incontinence.
Cardiac Arrest
- Cardiopulmonary arrest.
- Abrupt loss of heart function, breathing, and consciousness.
- Electrical malfunction causing the heart to stop beating, preventing oxygen-rich blood from being pumped to the brain, lungs, and other organs.
- May occur after myocardial infarction but often has other causes.
Cardiac Arrest - Management
- The longer the arrest, the less the chance of restoring a healthy life.
-
Chain of survival:
- CPR to provide circulatory support.
- AED (if shockable rhythm present - ventricular fibrillation or pulseless ventricular tachycardia).
Maintaining Emergency Care Knowledge
- Dental professionals should continuously update their knowledge to provide excellent care for patients in an emergency.
Cardiovascular Diseases
- Coronary Heart Disease: Blockage in coronary arteries limits blood flow to the heart muscle.
- Cerebrovascular Disease: Affects blood vessels supplying the brain, including stroke and transient ischemic attacks (TIAs).
- Peripheral Vascular Disease (PVD): Affects blood vessels outside the heart and brain, often in legs and feet. May lead to intermittent claudication, poor wound healing, and amputation.
- Deep Vein Thrombosis (DVT) & Pulmonary Embolism: Blood clots in deep veins, potentially traveling to the lungs.
- Valvular Heart Disease: Damage or dysfunction of heart valves (stenosis, regurgitation, prolapse).
- Congenital Heart Disease: Heart defects present from birth, such as septal defects, transposition of great vessels, and tetralogy of Fallot.
Atherosclerosis
-
Stages of Atherosclerosis:
- Endothelial Injury: Damage to artery lining caused by factors like hypertension or smoking.
- Fatty Streak: Lipid accumulation beneath the damaged endothelium.
- Inflammatory Response: White blood cells and foam cells form.
- Plaque Progression: Smooth muscle cells migrate, calcification occurs, and a fibrous cap forms.
- Plaque Disruption: Plaque rupture leads to thrombosis and potential heart attacks.
-
Complications of Atherosclerosis:
- Thrombosis: Blood clots that block arteries.
- Infarction: Tissue death due to lack of oxygen.
- Embolus: A clot or plaque fragment that travels to block heart or brain arteries, causing heart attack or stroke.
- Ischaemic Heart Disease: Reduced blood supply to heart tissue, leading to angina or heart attack.
-
Risk Factors for Atherosclerosis:
- Physical Stress: Turbulent blood flow, especially at artery branches.
- Smoking/Air Pollution: Circulation of reactive oxygen species.
- Dyslipidaemia: High LDLs and low HDLs.
- Chronic Elevated Blood Glucose: Associated with diabetes.
Ischaemic Heart Disease
-
Conditions associated with Ischaemic Heart Disease:
- Angina Pectoris: Chest pain caused by narrowed coronary arteries, classified as stable (triggered by exertion) or unstable (may occur at rest).
- Myocardial Infarction (Heart Attack): Sudden blockage of coronary arteries, leading to heart muscle death.
-
Risk Factors for Ischaemic Heart Disease:
- Age: Risk increases with age.
- Smoking: Damages arteries and promotes atherosclerosis.
- Hyperlipidaemia: High cholesterol levels increase plaque formation.
- Hypertension: High blood pressure accelerates arterial damage.
Hypertension (High Blood Pressure)
-
Types of Hypertension:
- Primary (Essential) Hypertension: 90% of cases with no known cause, associated with age, obesity, and high salt intake.
- Secondary Hypertension: 10% of cases, resulting from diseases such as renal or endocrine disorders.
-
Risk Factors for Hypertension:
- Genetic and Familial Tendencies: Runs in families.
- Obesity: Increases strain on heart and arteries.
- High Salt Intake: Raises blood pressure by causing water retention.
- Stress: Psychological stress can raise blood pressure.
-
Complications of Hypertension:
- Stroke: Increased risk of cerebral blood vessel rupture or blockage.
- Heart Failure: Chronic high pressure weakens the heart.
- Vision Loss: Damage to blood vessels in the retina.
- Vascular Dementia: Cognitive impairment caused by reduced blood flow to the brain.
Risk Factors for Cardiovascular Disease
-
Lifestyle Factors:
- Unhealthy Diet: High in saturated fats, salt, and sugars can lead to obesity and atherosclerosis.
- Smoking: Damages arterial walls and promotes atherosclerosis.
- Alcohol: Excessive consumption raises blood pressure and contributes to obesity.
- Physical Inactivity: Leads to obesity and poor cardiovascular fitness.
-
Other Factors:
- Hypertension: High blood pressure accelerates arterial damage.
- High Cholesterol: Elevated LDL cholesterol contributes to plaque buildup.
- Diabetes: Chronic high blood sugar damages arteries.
- Family History: Genetic predisposition to cardiovascular diseases.
Myocardial Infarction (Heart Attack)
-
Symptoms of Heart Attack:
- Severe, crushing pain in the center of the chest, potentially radiating to the left arm or jaw.
- Other signs include sweating, nausea, vomiting, restlessness, confusion, and paleness.
- Silent Infarctions: Around 10-20% of patients may not experience pain.
-
Management of Heart Attack:
- Call emergency services immediately.
- Position the patient comfortably.
- Use glyceryl trinitrate (GTN) spray for known angina.
- Administer 300 mg of dispersible aspirin if not allergic.
- Provide oxygen if needed and be ready for CPR.
-
Complications of Heart Attack:
- Immediate: Cardiac arrhythmias, cardiac failure, pericarditis.
- Long-term: Risk of angina, aneurysms, cardiac rupture, psychological problems like depression.
Cerebrovascular Disease (Stroke & TIA)
-
Types of Stroke:
- Ischaemic Stroke: Caused by a clot (embolism or thrombosis) obstructing a cerebral artery.
- Haemorrhagic Stroke: Caused by a blood vessel rupture, leading to bleeding in the brain.
- Transient Ischaemic Attack (TIA): Also called a mini-stroke, symptoms last less than 24 hours but indicate a high risk of future stroke.
-
Signs of Stroke: Use the FAST test (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services).
Peripheral Vascular Disease
-
Causes of Peripheral Vascular Disease:
- Often caused by atherosclerosis, narrowing or blocking arteries in the limbs.
-
Symptoms of Peripheral Vascular Disease:
- Pain in the legs (intermittent claudication), weak pulses, skin changes, slow wound healing.
- Advanced cases may lead to amputation due to poor circulation.
-
Vein Involvement in Peripheral Vascular Disease:
- Varicose Veins: Dilated veins, usually in the legs, causing pain and discomfort.
- DVT: Blood clots in deep veins, potentially traveling to the lungs, causing pulmonary embolism.
Cardiac Arrest
-
Definition of Cardiac Arrest: A sudden loss of heart function, breathing, and consciousness due to electrical malfunction.
-
Management of Cardiac Arrest:
- Immediate CPR (cardiopulmonary resuscitation) to maintain blood flow to vital organs.
- Use of AED (Automated External Defibrillator) if the heart's rhythm is shockable (ventricular fibrillation or tachycardia).
- Fast medical intervention is critical for survival.
Clinical Considerations in Dental Care for CVD Patients
-
Considerations:
- Detailed medical history review, especially regarding medications (e.g., anticoagulants).
- Be prepared for potential medical emergencies during dental procedures.
- Modify dental treatments to reduce stress (e.g., morning appointments, short sessions).
- Pay attention to postural changes to prevent dizziness or fainting.
- Communicate with the patient's GP or cardiologist when necessary.
-
Emergency Preparedness:
- Dentists must stay updated on CPR and AED use to manage cardiovascular emergencies during treatment.
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Description
This quiz covers the essentials of cardiovascular disease, including its types, risk factors, and statistics related to its impact in the UK. Test your knowledge on conditions such as coronary heart disease and understand the lifestyle choices that contribute to CVD. Explore importants facts and the burden of this disease on healthcare systems.
