Cardiovascular Disease: Types, Risks & UK Statistics

Cardiovascular Disease Overview

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

UK Statistics on CVD

• 7.6 million people live with cardiovascular disease.
• There are 450 deaths every day related to CVD.
• Heart attacks account for approximately 100,000 hospital admissions yearly.
• There is one stroke approximately every 5 minutes.
• Total annual healthcare costs for CVD are £9 billion.

Types of Cardiovascular Disease

• Coronary heart disease affects the arteries supplying the heart.
• Cerebrovascular disease affects the arteries supplying the brain.
• Peripheral vascular disease affects the arteries and veins supplying the limbs.
• Deep vein thrombosis and pulmonary embolism involve blood clots in the veins.
• Valvular heart disease affects the heart valves.
• Congenital heart disease is present at birth.

Lifestyle Risk Factors for CVD

• Unhealthy diet, particularly high in salt can increase CVD.
• Physical inactivity is a risk factor.
• Obesity is a risk factor.
• Smoking increases CVD risk.
• Alcohol consumption risk factor.

Other Risk Factors for CVD

• Hypertension increases CVD risk factors.
• High cholesterol levels increase risk factors.
• Diabetes mellitus increases risk factors
• Kidney disease is a risk factor.
• Increasing age increases risk factors.
• Gender is a factor, males at higher risk, but this changes post menopause in females
• Ethnicity can increase risk factors in individuals.
• Family history can increase risk factors.

Atherosclerosis

• Underlying CVD condition with arteries narrowing due to plaque buildup (atheroma).
• Atherosclerosis limits oxygen-rich blood flow to organs.
• Endothelium in arteries sustains chemical or physical damage triggering a chronic inflammatory response.

Stages of Artherosclerosis

• Endothelial injury or dysfunction is the initial stage.
• Fatty streak is characterized by accumulation of lipids beneath the damaged vessel.
• Inflammatory response involves recruitment of white blood cells and foam cell formation.
• Plaque progression involves smooth muscle cell migration, connective tissue increase, calcification, platelet adhesion, and fibrous cap formation.
• Plaque disruption and potential thrombosis.

Risk Factors for Atherosclerosis

• Physical stress on arteries increases risk.
• Turbulent blood flow increases risk.
• Smoking/air pollution risk from reactive oxygen radicals.
• Dyslipidaemia, including high total cholesterol, high LDLs, and low HDLs increases risk.
• Chronically elevated blood glucose levels also increase risk.

Complications of Atherosclerosis

• Thrombosis is possible which can completely block an artery.
• Infarction can occur due to impaired blood flow which leads to tissue death.
• Embolus can travel in bloodstream to the brain.
• Can result in Ischaemic heart disease, Angina, Myocardial infarction (heart attack).
• Can result in Cerebrovascular disease (stroke), Aneurysm, Peripheral vascular disease.

Ischaemic Heart Disease

• Ischaemia signifies a restriction of blood supply to tissues.
• Ischaemic coronary heart disease results from atherosclerosis and hypertension.
• Angina pectoris/ myocardial infarction (heart attack) can results
• Infarction can lead to acute failure of the entire circulation, loss of cerebral blood supply and death.
• Risk factors include: age, smoking, hyperlipidaemia, hypertension and diabetes.

Hyperlipidaemia

• High blood cholesterol, which can be familial.
• Can be associated with age, gender, inactivity, obesity, low dietary fibre, smoking, ethnicity, low socioeconomic status, and other diseases.
• Management includes lowering LDL levels and raising HDL levels through lifestyle changes.
• Statins are a medication option.

Angina Pectoris

• Severe chest pain caused by narrowing of the coronary arteries.
• Myocardial ischaemia is associated with increased blood lactic acid.
• It can manifest as squeezing, crushing, gripping substernal pain that may radiate to the left arm/jaw.
• Angina may be stable or unstable.

Angina Pectoris Management

• Relieved by rest or glyceryl trinitrate (GTN) medication.
• Vasodilation is stimulated via glyceryl trinitrate to decrease angina.
• Pain resolves in 2-3 minutes.
• Aspirin, calcium channel blockers, beta blockers, ACE inhibitors, and statins may be required.
• Angioplasty or surgery to place stents or perform coronary artery bypass graft.

Myocardial Infarction

• Heart attack / coronary thrombosis, a sudden injury caused by blockage of a coronary artery.
• Rupture of a vulnerable atheromatous plaque can occur.
• Resultant ischaemia (oxygen shortage) leads to necrosis (tissue death) of the myocardium.

Myocardial Infarction Clinical Presentation

• Severe, central crushing pain radiating to the left arm or jaw may be present.
• Pain may start at rest and persist.
• Patients may shows signs of restlessness, facial pallor, sweating, nausea, vomiting, confusion, and apprehension.
• 10-20% of patients can feel no pain.
• Women may present with atypical symptoms.
• Ventricular fibrillation and cardiac arrest can happen after chest pain onset.

Myocardial Infarction Management

• Call 999 for emergency assistance.
• Place patient in comfortable position.
• Administer GTN spray if angina is known.
• Give dispersible aspirin 300mg chewed (unless clear evidence of allergy to it).
• Administer oxygen if patient is hypoxaemic. Have CPR/AED equipment ready.
• Immediate hospital admission for ECG, blood tests, echocardiogram.
• Hospital will administer Oxygen and analgesics.
• They may need to perform a Thrombolytic therapy.
• They may use some Anticogulants.
• Possible ACE inhibitors, sedative, bed rest and/or surgery.

Myocardial Infarction Complications

• Outlook depends on how quickly the onset is related to the treatment.
• Acute complications include cardiac dysrhythmias, cardiac failure, and pericarditis.
• Later complications: angina, thromboembolism, aneurysm, and cardiac rupture.
• Longer term: post MI syndrome, psychological problems and depression.

Cardiac Arrest

• Cardiopulmonary arrest leading to abrupt loss of heart function, breathing, and consciousness.
• Electrical malfunction of the heart prevents oxygen rich blood to the brain, lungs and other organs due to this cardiac arrest.
• May occur after a myocardial infarction but oftern has alternate cause.

Cardiac Arrest Consequences

• Cerebral hypoxia causes respiratory arrest and brain injury.
• Survivors may experience personality changes, memory and speech impairment, involuntary movements, and incontinence.

Cardiac Arrest Management

• The longer the arrest the less the possibility of restoring healthy life.
• Chain of survival includes early recognition and call for help, CPR to provide circulatory support, and AED if shockable rhythm is present.

Cardiac Devices

• Implantable cardiac loop recorders are available.
• Pacemakers can be used to treat certain heart conditions.
• Implantable cardioverter defibrillators are another option.

Pacemakers

• Medical device replacing or regulating the electrical conduction of the heart.
• Generates electrical impulses delivered by electrodes causing the heart muscle to contract and pump blood.

Cerebrovascular Disease

• Diseases and disorders affecting blood vessels of the brain and cerebral circulation.
• Causes include: stenosis, thrombosis, embolism, and haemorrhage.
• Includes cerebrovascular accident (stroke) and transient ischaemic attacks (TIAs).

Stroke and TIA

• Rapid onset and brain infarction characterizing a stroke.
• Ischaemic stroke: caused by embolism from a distant site or thrombosis of a cerebral vessel
• Haemorrhagic stroke: caused by an intracerebral or subarachnoid bleed
• Transient ischaemic attack (TIA): 'mini stroke' lasting <24hrs
• Approximately 1 in 8 people die within 30 days of having a stroke.
• Recognizing stroke and obtaining urgent medical attention is essential.

Peripheral Vascular Disease

• Blood circulation disorder of the circulatory system other than the brain or heart.
• May affect arteries, veins, or lymphatic vessels.
• Atherosclerosis is the often underlying cause.
• Most commonly affects the legs and feet.

Additional affects of PVD in Legs and feet include:

• Intermittent claudication
• Skin changes
• Weak pulses
• Slow wound healing with possible non-healing leg ulcers
• Numbness, weakness, or heaviness.

Peripheral Vascular Disease Complications

• Increased risk of stroke.
• Poor wound healing.
• Severe pain and restricted mobility.
• Amputation.

Peripheral Vascular Disease: Veins

• Can be associated with varicose veins and deep vein thrombosis (DVT).
• DVT is more likely following cerebrovascular accident or in patients with myocardial infarction.

Hypertension

####Overview

• Persistently raised blood pressure in excess of the desired range for an individuals sex and age.
• Increases the risk of cardiovascular, brain, kidney and other diseases.
• Estimated 1.13 billion people globally have hypertension.
• A major cause of premature death worldwide.

Measuring blood pressure

• Blood pressure is the force exerted by circulating blood against the artery walls.
• Measured in millimetres of mercury (mmHg) either systolic/diastolic.
• Hypertension = persistently 140/90mmHg.

Hypertension Primary (causes)

• Also known as 'essential hypertension' and accounts for up to 90% cases
• Cause unknown
• Risk factors include Genetics, familial tendencies, age, ethnicity, gender, obesity, alcohol, salt intake, stress/anxiety.
• And also, smoking and physical inactivity.

Hypertension Secondary (causes)

• Secondary to a known disease process and accounts for 10% cases
• Causes include:
• Renal disease
• Endocrine disease
• Cerebral disease
• Congenital heart defect
• Pregnancy
• Medications
• Drug use

Hypertension Complications

• 'Silent killer' increasing the risk of:
  • Arrhythmias
  • Angina
  • Myocardial infarction
  • Stroke
  • Aneurysm
  • Peripheral vascular disease
  • Heart failure
  • Vision loss
  • Kidney disease
  • Vascular dementia

Hypertension Management

• Lifestyle changes that include
  • dietary changes to decrease salt and saturated fats
  • increase fruit and vegetables
  • exercise
  • quit smoking
  • reduce alcohol intake
  • lower stress
• Medication examples:
  • Diuretics e.g. Frusemide, Bendrofluazide
  • Beta blockers e.g. Atenolol, Propanolol
  • Calcium antagonists e.g. Nifedipine, Verapamil, Diltiazem
  • ACE inhibitors e.g. Lisinopril, Enalapril

Aortic Aneurysm

• Localised balloon like bulges or enlargements in the artery wall.
• Weakness in the arterial wall is the cause.
• Most often abdominal.
• May remain silent for years.
• If it ruptures it can lead to life threatening haemorrhage.
• Causes can include atherosclerosis and hypertension commonly.
• Hypertension must be managed to prevent risk of rupture.

Orthostatic Hypotension

• Involves a sudden drop in blood pressure when getting up from supine position known as Postural hypotension.
• The individual may feel dizzy or faint, have blurred vision, or feel nauseous.
• It is common in people taking antihypertensive medication, in the elderly, or because of heart valve disorders, pregnancy and dehydration.

Congenital Heart Disease

• Present in approximately 1% of live births.
• This condition can involve the heart or adjacent great vessels.
• It may be associated with other anomalies elsewhere in the body.
• Can be classified as cyanotic or acyanotic.
  • Cyanotic involves right to left shunting, bypassing lungs, and it is more severe.
  • Acyanotic involves left to right shunting of oxygenated blood.

Valvular Heart Disease

• Damage or disease affects the heart valves.
• Stenosis: when a valve can't open fully restricting blood flow
• Regurgitation: valve cannot close fully causing backflow of blood
• Prolapse: valve can slip out of place or the valve flaps (leaflets) do not close properly
• These conditions can be acquired or congenital.

Rheumatic Fever and Endocarditis

• Rheumatic fever is an inflammatory disease which can start commonly as a streptococcal sore throat.
• Inflammatory factors can involve damaging heart valves which results scarring.
• Infective endocarditis (IE) is a rare infection where organisms enter the bloodstream.
• These organisms infect the endocardium of the heart.
• IE occurs most frequently in patients with valvular heart disease or prosthetic valves.
• Organisms can enter the bloodstream from the oral cavity creating the need for optimal oral hygiene.

Explore cardiovascular disease (CVD), a group of disorders affecting the heart like coronary and cerebrovascular diseases. Review UK statistics, including prevalence, daily deaths, hospital admissions for heart attacks, and healthcare costs. Learn about lifestyle risk factors such as unhealthy diet and physical inactivity.