CVS CM
CORONARY ARTERY DISEASES
Definition: A class of diseases that involves heart or blood vessels . It includes the
following:
1. Coronary heart disease
2. Cerebrovascular disease
3. Peripheral arterial disease
4. Rheumatic heart disease
5. Congenital heart disease
6. Deep venous thrombosis
7. Pulmonary embolism
The most common reason of vessel blockage is atherosclerosis.
Causes of stroke: 1. Vessel blockage, bleeding in the brain or blood clots.
Modifiable Risk factors of CAD
1. Raised systolic blood pressure
2. Raised diastolic blood pressure
3. Smoking
4. Raised LDL
5. Reduce HDL
6. Left ventricular hypertrophy
7. Hyperglycemia
8. Renal disease
9. Micro albuminuria
10. Obesity, BMI
11. Sedentary lifestyle
Non Modifiable Risk factor
1. Age
2. Gender
3. Family history
4. Previous cardiovascular event
5. Previous cerebrovascular event
6. Race
Minor Risk factors
1. Decreased level of copper
2. Decreased level of zinc
3. Decreased water hardness
4. Hypercalcemia
5. Hypercoagulability
6. Vasectomy
7. Coffee consumption
8. Hyperuricemia
9. Post cardiac transplantation.
New and emerging risk factors
1. Estrogen deficiency
2. Increased homocysteine
3. Increased plasma fibrinogen
4. Increased factor 7
5. Increased plasminogen activator inhibitor type 1
6. Increased D dimer
7. Increased c reactive protein
8. Increased lipoprotein
9. Increased endogenous tissue plasminogen activator
10. Chlamydia and pneumonia infection.
PRIMARY PREVENTION OF CVDs
1. Health education
2. Healthy diet pattern
3. Physical activity
4. Smoking cessation
5. Reduced intake of foods that are high in salt ,fat , and sugars
6. Alcohol abstinence
SECONDARY PREVENTION
Treatment with
1. Aspirin 75mg OD , daily
2. Beta blockers : slow heart rate , reduce pumping power of heart thus
reducing the oxygen demand of heart. They also widen blood vessels , thus
reducing blood pressure.
3. Ace inhibitors: used in people with heart failure or after heart attack to
lower BP.
4. Statins: lower cholesterol levels thus slow down the process of
atherosclerosis .
75 percent of recurrent vascular events can be prevented by using above
mentioned intervention with smoking cessation.
Currently, there are major gaps in the implementation of above-mentioned
interventions particularly at primary health care level.
Surgery: Angioplasty( PCI) , stent( flexible mesh tube… can release drug) ,
CABG.
Framingham heart study ( cohort study, began in 1948, with 5209 adult
subjects and it is now on its 3rd generation.
Acc to WHO, CVDs are the no 1 cause of death globally.
How to address CVDs?
Address social determinants of health.
1. Surveillance
2. Prevention
3. Management.
HYPERTENSION
It is an iceberg disease
Rule of half ( most imp)
Starting from the core :
1. Adequately treated
2. Diagnosed and treated
3. Diagnosed hypertension
4. Hypertensive subject
5. Whole community
PRIMARY PREVENTION
1.Population strategy
Nutrition, dietary modification, reduction of salt intake( not more than 5mg/ day),
moderate fat intake, reduction of alcohol intake , reduction of calorie intake.
Weight reduction , exercise promotion, behavioral changes , health education,
self care.
2. High Risk strategy
Detection of high risk cases by clinical methods, family histories ,life styles and
dietary patterns etc.
SECONDARY PREVENTION
1. Early case detection
2. Treatment
3. Compliance
TYPES OF HYPERTENSION
ESSENTIAL: idiopathic, 95 percent cases.
SECONDARY: underlying cause like intrinsic renal disease, renovascular disease,
mineralocorticoid disease , mineralocorticoid excess, sleep breathing disorder.
Uncommon causes include: pheochromocytoma, glucocorticoid excess ,
coarctation of aorta, hyper/hypothyroidism.
COMPLICATIONS
1. Heart failure
2. Left ventricular hypertrophy
3. Myocardial infarction
4. Coronary heart disease
5. Hypertensive encephalopathy
6. Cerebral hemorrhage
7. Preeclampsia/ eclampsia
8. Stroke
9. Chronic kidney failure
10. Blindness
11. Aortic aneurysm
12. Gangrene of lower extremity
GOALS OF ANTIHYPERTENSIVE THERAPY
1.Reduce cardiac and renal morbidity and mortality.
2. Treat to BP less than 140/90 mmHg or BP less than 130/80mmHg in patients
with diabetes or CKD.
LIFESTYLE MODIFICATION
DASH DIET
1. Low to moderate intake of saturated fats, cholesterol and total fats. Prefer
low fat / non fat dairy. Low to moderate intake of poultry and meat.
2. Diet in High in fibre, legumes,nuts , rich in whole grains and grain products ,
fruit and vegetables.
3. Rich in potassium, calcium and magnesium.
4. Recommend sodium intake not more than 2400mg/ day.
CAUSES OF RESISTANT HYPERTENSION
1. Improper BP measurement
2. Excess sodium intake
3. Inadequate diuretic therapy
4. Inadequate doses, drug interactions, drug action, some herbal
supplements.
5. Excess alcohol intake.
Streptococcus pharyngitis
It is the infection of back of the throat including tonsils causes by group a beta
hemolytic streptococcus . Common symptoms include, fever, sore throat, red
tonsils and enlarged lymph nodes in the neck. Other symptoms include
odynophagia( painful swallowing) , red and swollen tonsils sometimes with
white streaks, tiny red spots on the area at the back of the roof of the mouth. (
Soft palate and hard palate)
Gold standard Dx: positive throat culture.
Acute rheumatic fever: It is an inflammatory disease that involve heart, joints ,
skin and brain. It an autoimmune consequence of infection with group a strep
coccus . Results in generalized inflammatory response.
Diagnosis is based on Duckett Jones Criteria.
RHEUMATIC HEART DISEASE
Permanent heart valve damage resulting from one or more attacks of acute
rheumatic fever.
BURDEN OF DISEASE
40 to 50 percentage of patients with R.F will develop RHD. RHD is preventable
and treatable. It affects poorest population in the world.
RHD COMPLICATION: heart valve damage , stroke , heart failure and death.
Most commonly affected valves are Mitral and aortic valve.
RHD is the M/c disease in the children and youth.
Risk factors, poverty, poor hygiene and over crowding.
Symptoms: Palpitations, breathlessness on exertion, orthopnea ( breathing
problem with lying down), paroxysmal nocturnal dyspnea ( waking from the sleep
with the need to sit and stand up), fever associated with infection and stroke.
PRIMARY PREVENTION OF RHD
1. Identifying strept throat infection and treating them with Penicillin .
2. Surveillance of high risk group such as school children .
3. Treatment with Penicillin( <oral or > IM) even in unavailability of laboratory
facilities.
4. Good dental hygiene.
5. Good prenatal care .
SECONDARY PREVENTION OF RHD
1. Prevention of reoccurrence of R.F
2. Identification of recurrent cases of R.F
3. Injection of Benthazine Benzyl Penicillin (1.2million units in adults and
600000 units in children at interval of 3 weeks for 5 years.
TERTIARY PREVENTION
1.Hospital admission to treat heart failure.
2. Antibiotics for infection especially for heart valves.
3. Blood thinning medicine to prevent stroke and Thin blood for replacement
valve.
4. Balloons inserted through veins to open up stuck valves.
5. Heart valve surgery.
i
i BY MADIHA WASEEM
