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Questions and Answers
Which of the following best defines cardiovascular disease?
Which cardiovascular disease is characterized by narrowed arteries supplying blood to the heart?
What is the annual healthcare cost associated with cardiovascular disease in the UK?
Which of the following is NOT considered a type of cardiovascular disease?
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What lifestyle factor is commonly identified as a risk for developing cardiovascular disease?
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How frequently does a stroke occur, according to statistics provided?
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Which of the following is a common medical emergency related to cardiovascular disease?
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What population statistic reflects the prevalence of cardiovascular disease in the UK?
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Which of the following risk factors is NOT related to atherosclerosis?
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What is a common complication of atherosclerosis?
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What defines angina pectoris?
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What is a primary management strategy for hyperlipidaemia?
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Which statement about myocardial infarction is true?
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What physiological response occurs during the initial stage of atherosclerosis?
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Which lifestyle factor is a significant risk factor for cardiovascular disease?
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Which of the following is a symptom of myocardial ischaemia?
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Which medications may be required for the management of angina pectoris?
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Which of the following is a hallmark of atherosclerosis progression?
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What is the most common symptom of a myocardial infarction?
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What management step should be taken first for a suspected myocardial infarction?
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Which of the following is a possible complication that can occur later after a myocardial infarction?
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What percentage of myocardial infarction patients may experience silent infarctions without chest pain?
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Which of the following is a recommended treatment for an acute myocardial infarction?
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Which factor is crucial for improving the outcome of a cardiac arrest situation?
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What is one of the immediate interventions for a patient in cardiac arrest?
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Which of the following symptoms may indicate atypical presentation of a myocardial infarction in women?
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What consequence might survivors of cardiac arrest experience?
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Which medication should be avoided if there is clear evidence of an allergy to it during myocardial infarction treatment?
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Study Notes
Cardiovascular Disease (CVD)
- CVD refers to a group of disorders of the heart and blood vessels
- 7.6 million people in the UK live with CVD
- 450 deaths occur daily in the UK due to CVD
- CVD accounts for 100,000 hospital admissions annually in the UK
- CVD is the leading cause of death globally
- The total annual healthcare cost of CVD in the UK is £9 billion
Types of CVD
- Coronary heart disease
- Cerebrovascular disease
- Peripheral vascular disease
- Deep vein thrombosis and pulmonary embolism
- Valvular heart disease
- Congenital heart disease
Risk Factors for CVD
-
Lifestyle:
- Unhealthy diet (high salt intake)
- Physical inactivity
- Obesity
- Smoking
- Alcohol
-
Other:
- Hypertension
- High cholesterol
- Diabetes
- Kidney disease
- Age
- Gender
- Ethnicity
- Family history
Atherosclerosis
- The underlying cause of most CVD
- Narrowing of arteries due to the build-up of plaques (atheroma)
- Restricts the flow of oxygen-rich blood to organs
- Caused by damage to the endothelium of the artery, triggering a chronic inflammatory response
Stages of Atherosclerosis
- Endothelial injury or dysfunction
- Fatty streak - Lipids accumulate beneath the damaged endothelium
- Inflammatory response – Recruitment of white blood cells and foam cell formation
- Plaque progression – migration of smooth muscle cells, increased connective tissue, calcification, platelet adhesion and fibrous cap formation
- Plaque disruption
Risk Factors for Atherosclerosis
- Physical stress on arteries (turbulent flow at branch points)
- Smoking/air pollution (circulation of reactive oxygen radicals)
- Dyslipidaemia (High total cholesterol, high LDLs, low HDLs)
- Chronically elevated blood glucose levels
Complications of Atherosclerosis
- Thrombosis - Complete blockage (occlusion) of the artery
- Infarction - Tissue death due to impaired blood flow
- Embolus - A blood clot that travels in the bloodstream and can block an artery
- Ischaemic heart disease, Angina, Myocardial infarction (heart attack), Cerebrovascular disease (stroke), Aneurysm, Peripheral vascular disease
Ischaemic Heart Disease
- Restriction of blood supply to tissues
- Caused by atherosclerosis and hypertension
- Leads to angina pectoris and myocardial infarction
- Infarction can lead to acute circulatory failure, loss of cerebral blood supply and death
- Risk factors: age, smoking, hyperlipidaemia, diabetes, hypertension
Hyperlipidaemia
- High blood cholesterol
- May be familial (inherited)
- Associated with: age, gender, inactivity, being overweight, low dietary fiber, smoking, ethnicity, low socioeconomic status and other diseases (hypertension, diabetes and chronic kidney disease)
- Management aims to lower LDL levels and raise HDL levels through lifestyle changes
- Statins may be required
Angina Pectoris
- Chest pain caused by narrowing of the coronary arteries
- Associated with myocardial ischaemia and increased blood lactic acid
- Squeezing, crushing, gripping substernal pain (may radiate to left arm/jaw)
- Can be stable or unstable
Angina Pectoris - Management
- Relieved by rest or glyceryl trinitrate (GTN) medication
- GTN stimulates vasodilation, resolving pain within 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 required
Myocardial Infarction
- Heart attack or coronary thrombosis
- Sudden injury caused by blockage of a coronary artery
- Rupture of a vulnerable atheromatous plaque
- Ischaemia (oxygen shortage) leads to necrosis (tissue death) of the myocardium
Myocardial Infarction - Clinical Presentation
- Severe, central crushing pain radiating to 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
- Call 999 for emergency assistance
- Immediate hospital admission
- Comfortable position
- GTN spray if known angina
- Dispersible aspirin 300mg chewed (unless clear evidence of allergy)
- Oxygen if the patient is hypoxaemic
- Monitor and be prepared to start CPR/AED
- ECG, blood tests, echocardiogram
- Oxygen
- Thrombolytic therapy
- Analgesics
- Anticoagulants
- ACE inhibitors
- Sedatives
- Bed rest
- Surgery
Myocardial Infarction - Complications
- Outlook depends on the time from onset to treatment
- Acute - cardiac dysrhythmias, cardiac failure and pericarditis
- Later – angina, thromboembolism, aneurysm, cardiac rupture
- Longer term - post MI syndrome (known as Dressler’s syndrome), shoulder-hand syndrome, psychological problems and depression
Cardiac Arrest
- Abrupt loss of heart function, breathing and consciousness
- Electrical malfunction in the heart prevents oxygenated blood being pumped to the brain, lungs and other organs
- Can occur after a myocardial infarction but often has other causes
Consequences of Cardiac Arrest
- Cerebral hypoxia causes respiratory arrest and brain injury
- Survivors may experience personality changes, memory and speech impairment, involuntary movements, and incontinence
Management of Cardiac Arrest
- The longer the arrest lasts, the less likely a healthy life can be restored
- Chain of survival:
- CPR to provide circulatory support
- AED if shockable rhythm present (ventricular fibrillation or pulseless ventricular tachycardia)
Maintaining Knowledge for Dental Emergency Management
- Ongoing professional development, including CPD courses
- Continued exposure to emergency situations via simulations and clinical practice
- Membership of professional organizations that provide resources and training
- Maintaining up-to-date knowledge of relevant clinical guidelines
- Staying informed about current research and advancements in emergency medicine
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Description
This quiz provides an overview of cardiovascular disease (CVD), including its types, risk factors, and impact on public health. Understand the significance of CVD as a leading cause of mortality and its associated healthcare costs in the UK. Test your knowledge about atherosclerosis and the lifestyle choices that contribute to CVD.
