Please enable JavaScript.
Coggle requires JavaScript to display documents.
W7 Cardiovascular disease: Coronary Heart Disease & Stroke &…
W7 Cardiovascular disease: Coronary Heart Disease & Stroke & Hypertension
Hypertension
is a maj risk RF & antecedent of CVD:
MyoInf
CHD
Stroke (ischaemic & haemorrhagic)
Chronic kidney disease
Heart failure
premature death
RFs for hypertension - 95% of hypertension
Diet: high salt intake
overweight & obesity
excessive alcohol consumption
insufficient phys act
low dietary K+
age
What is it?
systolic BP: represent max pressure in the arteries when the heart muscle contracts to pump bld
High-normal= 130-139mmHg
diastolic BP: reflects min pressure in the arteries when the heart muscle relaxes before its next contraction
High-normal= 85-89mmHg
4 facts abt HT
HT is common: 1 in 3 Aus have it
Maj RF for CHD & Stroke: 42% of the burden of CVD
in 2012-13: 6mil AUs (34%) aged 18 had HT or were taking antihypertensive med
4.1mil Aus had uncontrolled or untreated HT
Controlling HT
Targeted (high-risk): in the past, most efort been directed @ grp of ⤒lvls of BP
Pop (Universal): who make up largest share of the pop w/ mild HT
more effective strat: lower BP lvl of entire pop- ⇊ of sodium intake or ⇈ phys act or ⇊ weight
Targeted (high-risk)- issues
prioritise screening of ppl w/ diabetes or HT (known medical RFs) or ppl w high risk score based a combo of their RFs
Population (universal) - issues
benefits of statins on pop: accepted, BUT ~> over-medicalising
healthy ppl prescribed meds tht they don't need
⇒ ⇈healthcare costs awa potential exposure to side effects
reqs high lvls of support, funding, awareness, uptake & monitoring
∴univ screening will never reach whole of pop
good: can help identify ppl who go on to develop HD who may not have been identified thru targeted approaches
reduce risk & ultimately save lives or improve quality of life
ACS
acute myocardial infarction (heart attack) & unstable angina (chest pain @ rest)
Signs & Symptoms
Myocardial Infarction
chest discomfort
recurrent chest pain
pain radiation to jaw, neck & upper limb
severe pain
shortness of breath
sweating, pallor
tachycardia (fast heart beat) / bradycardia (slow HB)
lightheaded
nausea/vomiting
fatigue
palpitations
Death from CHD
1/2 die before reaching hospital
more than 4/10 die within first year
25% die within first hour of symptoms
Discharge 2o management
aspirin + 2nd antiplatelet medication
statins to lower ch.
BP lowering med
lifestyle advice: quit smoking, diet, exercise, adhere to meds, maintain social contacts (avoid depression)
attend cardiac rehab or some tye of 2o prevention service [prevent a 2nd heart attack]
CVD Risk factors
Modifiable
Biomedical
hypertension: 29% adults
high ch.: 52% adults
excess weight: 54% adult
depression/socially isolated: 15% reported in patients after MyoInf
diabetes: 5% of pop
Behavioural
Tobacco smoking: 15.4% adults are current smokers
Inadequate exercise: 34% adults not sufficiently active
Insufficient diet:
46% inadequate fruit consump
85.6% inadequate vege consump
excessive alcohol consump: 10-14% drink @ harmful lvls
Non modifiable
Older age
Ethnicity
Family history of CVD [esp @ younger age]
3 lvls of prevention
1o prevention
targets RFs leading to injury/disease
universal/targeted screening
eg. Statins
2o prevention
prevents injury/disease once exposure to RFs occurs but still in early "preclinical" stage
manage bld pressure
blood clots: anti clotting meds
adjust lifestyle factors: more exercise
interventions: stenting or widening certain bld vessels
Statins
3o prevention
rehabilitating persons w/ injury/disease to reduce complications
Stroke
2 main types
Ischaemic stroke
Haemorrhagic
RFs
Lifestyle factors
high BP
high ch.
smoking
obesity or overweight
poor diet
inadequate exercise
alcohol
Medical factors
transient ishaemic attack (TIA)
irregular pulse (atrial fibrillation)
diabetes
fibromuscular dysplasia (FMD)
Atrial fibrillation (AF)
heart beating irreg⇒ ⇈chance of clot forming
almost 25% of first ever strokes spec caused by AF
at least half of strokes in ppl w/ undiagnosed or diagnosed but untreated AF could be avoided w/ use of effective stroke prevention meds
Non mod
Age
Gender
Fam hist
Symptoms
motor impairments (weakness, numbness or paralysis of parts of body: face, arm, leg)
sensory impairments (touch, pain, warm/cold), most often on one side
speech difficulties, loss or slurred
comm difficulties
vision difficulties
dizziness, loss of balance or coord or unexplained fall
sudden severe headache
difficulty swallowing
cognition issues
Stroke Recog: Community Ed
Face
Arms
Speech
Time
FAST mnemonic identifies 89% of stroke and TIA cases
Transfer of care to Stroke Care Units
the ED includes appropriate iagnosis of stroke & immediate referral to a stroke team
this early mngmnt of stroke: vital to minimise risk of complications in early stages of stroke
est: stroke unit care reduces death & disability by 20%
6 Facts on Stroke
2010: Stroke event rates fell by 25% between 1997 - 2009
BUT ^ stroke events ⇈d by 6% in the same period - ageing pop
2009-10: Stroke deaths rates declined in Aus by 70% between 1979-2010
8,300 deaths accounting for 6% of all deaths
1 in 5 who have their first stroke will die within a month
35% have disability caused by stroke