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Atherosclerosis (atheroma)
A disease proces of hardening or narrowing of the arteries due to excessive build up of plaque within the artery, reducing the ease of blood flow through artery.
Three stages:
Fatty streaks- damage to inner wall of the artery allows infiltration of fatty substances. Damage is minimal and blood flow not affected, reversible
- Soft plaque - Repeated injury at the site of fatty plaques resulting in thickening of artery's middle layer. Bulges into channel of artery restricting blood flow.
- Change occur by 30 years of age.
- All three artery's wall is affected
- Hard plaque - all three layers of artery's wall affected
- artery's channel is now almost blocked.
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Affect of atherosclerosis
Atherosclerosis of the arteries to the brain can lead to stroke
to the leg lead to gangrene
to the heart lead to angina or heart attack
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Hypertension
- >When systolic is above 140 and diastolic above 90
- >Bp is the results of cardiac output and peripheral resistance
- >Increase in cardiac output > increase stroke volume> increaes heart rate.
- >Increase peripheral resistance may be due too vasoconstriction of ateries vessels or excessive fluid volume in vascular space
- >Meds control blood pressure level to lower it
- >may experience fatigue, depression, sexual desire
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What cause hypertension?
- >Unknown, may be due to high salt intake, genetics and obesity and ageing
- >secondary hypertension causes narrowing of aorta, renal, endocrine, neurological
- >Narrowing of renal artery cause hypertension due to the impair circulation of blood to the kidney, causing kidney to produce renin and angiotensin (hormones)
- >these hormones along with aldosterone cause constriction and incresed stiffness in peripheral arteries throughout the body resulting in hypertension.
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Problem associated with hypertension
Hypertension can lead to:
- Myocardial infactions ( heart attack)
- Cerebrovascular accidents
- Renal disease
- Atheroclerosis
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Age and hypertension
- >Bp rises with age
- >more common in young, middle male adulthood
- >more common in women aged 55+
- >Age related changes is dud to loss of tissue elasticity, stiffness of myocardium, increased peripheral resistance, decreased renal function, decreased renin response to sodium and water reduction
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Glucose, Nicotine and hypertension
Nicotine causes vasoconstricion, carbon monoxide damages the lining of vessels
Abnormalities of glucose/insulin impairs vasodilation ( dilation of vessels)
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Treatment for hypertension
Lifestyle modifications
Medications- ace inhabitors, beta blockers, diuretic, calcium channel blockers
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Coronary artery disease (CAD)
- >major cause of illness/death
- >CAD begins when plaques are deposited within a coronary artery causing tiny clot to form which can obstruct flow of blood to heart muscle.
- >signs/symptoms include:
- chest pain - from inadequate blood flow to heart
- heart attack - sudden total blockage of coronary artery
- Sudden death - fatal disturbance of heart rhythm
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Angina
- >Common symptom of heart disease
- >described as unpleasant feeling or discomfort, tightness on chest
- >Lasts a few minutes and can be relieved by rest or medication (glyceryl trinitrate - GTN)
- >may develop without knowing
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Heart attack
- >Complet blockage of blood flow to part of heart muscle causes permanent damage to heart muscle
- >Pain last more than 15mins and cannot be relieved my mediacation ( GTN)
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Treating Angina
Nitrate is commonly used to treat angina. Nitrate relax the blood vessels, opening them wider so blood can flow more freely.
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What cause Angina?
- >Fatty deposits build up under the lining of coronary arteries causing arteries to become narrowed and reducing blood flow to heart
- >pain (angina) occurs due to insufficient blood flow
- >usually felt across centre of chest sometime both shoulders, neck, jaw, down arms and hands
- > brought on by exertion, emotion, after heavy meal, cold weather, resting or at night time.
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Coronary antioplasty (artery opening)
- > A procedure used to widen the narrowing in a coronary artery using special balloon.
- > narrowing is caused by build-up of plaque in the walls of arteries
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Prevention of Cardiovascular disease
- >By doing cardio vascular risk assessment and promoting lifestyle changes to reduce risks.
- > people with diabetes, renal disease, genetic lipid disorders are highly at risk
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High cholesterol
fasting blood test
- Ratio is a good indicator of coronary heart disease
- The higher the ration the higher the risk of CVD
- LDL accounts for 60-70% of cholesterol
- HDL accounts for 30%
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Measure of weight and truncal obesity
BMI- weight and height
- Waist circumference
- Men- > 102cm
- Women>88cm
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Risk assessment
Use national heart foundation cardiovascular risk tables
aims to reduced risk by 15%
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Intervention
healthy eating
Physical activity
Healthy weight
Quit smoking (ABC smoking cessation)
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Medications that help reduce CVD risks
Asprin
Statins
Blood pressure lowering medications
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