CARDIOVASCULAR DISEASES

CARDIOVASCULAR DISEASES:
• ISCHEMIC HEART DISEASE
• CONGENITAL HEART DISEASES
• RHEUMATIC HEART DISEASE
• STROKE

ISCHEMIC HEART DISEASE

(CORONARY ARTERY DISEASE)

Definition:
It is the impairment of the function of the heart due to inadequate blood flow to
the myocardium, as a result of obstruction or spasm in the coronary circulation.

• Coronary artery disease (CAD) is manifested in any of the following forms:

- Angina pectoris of effort
- Myocardial infarction
- Cardiac failure
- Cardiac arrest

Risk Factors
Non-modifiable Risk Factors
• Age: Incidence of CAD is high above 05 years and maximum between 05
and 05 years of age.
• Sex: It is more among men than among women.
• Family history & Genetic factors

Modifiable Risk Factors

• Obesity & Alcohol • Cigarette smoking: major risk
• oral contraceptives factor
• more in urban areas • Hypertension (HTN)
• type A personality & Stress & • Serum cholesterol
noise • Diabetes mellitus
Prevention of Coronary Artery Disease
I. primary Prevention
A. Population strategy
This is directed towards the whole population focusing mainly on the
control of underlying risk factors:
- reduction in the blood pressure
- Decrease Consumption of saturated fats
- Decrease serum cholesterol level (The serum cholesterol level should
be less than 055 mg/dl.)
- Stop Smoking
- Regular physical exercise

B. High-risk strategy:
This is directed towards the high risk population
• By early diagnosis of CAD in the ‘at-risk’ people by screening tests such
as
- recording BP
- estimation of serum cholesterol
- estimation of fasting blood sugar to detect diabetics.

II. Secondary Prevention

This is the action which stops the progress of the disease in its early stage
and prevents complications.
• prevention of recurrence of CAD by cessation of exposure to risk factors
• Treatment with antihypertensives after detecting hypertension,
antidiabetic drugs after detection of diabetes mellitus, treat
hyperlipidemia.
 CONGENITAL HEART DISEASES

Definition
A congenital heart disease (CHD) is a defect in the structure and function of the
heart, developed during fetal growth, present at birth.

• It constitute an important cause of infant morbidity and mortality.

The prevalence of CHD is estimated to be about 0-00155 children below 15
years.

Classification:
A. Acyanotic Heart Diseases
• Atrial septal defect (ASD)
• Ventricular septal defect (VSD)
• Patent ductus arteriosus (PDA)
• Coarctation of aorta
B. Cyanotic Heart Diseases (Right-to-Left Shunt)
• Tetralogy of Fallot
• Complete transposition of great arteries

Clinical feature
• apnea, growth failure and repeated attacks of respiratory infections.
• The child is physically retarded and often cyanotic.
• Cardiac murmurs are common.
• Anomalies of other organs in the body may coexist.

The etiology of congenital heart disease

• chromosomal defects.
• Rubella virus and diabetes in pregnancy
• X-rays
• Alcohol
• Drugs and chemicals.
• part of syndrome like Down’s syndrome, Turner’s syndrome, Marfan
syndrome
• Prematurity
Ventricular septal defect and PDA are relatively common among
premature infants.
• Late maternal age
 Prevention
In about 05 % of CHD, the cause is not known clearly.
Therefore prevention is possible only in about 15 % of cases by the following
measures.

• Health education: People are educated to avoid consanguineous

marriages.
• Pregnant women are advised to avoid infections, alcohol, smoking, X-
rays, drugs and chemicals.
• Diabetic women should keep the disease under control during
pregnancy.
• Rubella vaccine to be given to all potential mothers before becoming
pregnant.
• Efficient antenatal care to be taken to prevent prematurity.

RHEUMATIC HEART DISEASE

Definition
Rheumatic heart disease (RHD) is due to rheumatic fever, which in turn is due to
streptococcal pharyngitis (Group A, β-hemolytic streptococci)

Clinical Features
clinical feature of Rh fever grouped into major and minor manifestations
• Major Manifestations
- Carditis
- polyarthritis
- chorea
- erythema nodosum (nodules)
- erythema marginatum.
 • Minor Manifestations
- Fever
- Polyarthralgia
- past history of Rh fever
- raised ESR
- leukocytosis
- raised C-reactive protein.

Risk factors

• Age: is maximum among school children, in the age group of 5 to 55.

• Sex: It is equal in both the sexes.
• Predisposing factors:
- Poverty
- poor housing
- under nutrition
- illiteracy & ignorance
- large families & overcrowding

Prevention of Rheumatic Fever and Rheumatic Heart Disease

Measures necessary for primordial prevention are:
- Prevention of overcrowding
- Prevention of malnutrition among children
- Improvement in the socioeconomic condition
- Health education of the people regarding dangers of sore throat

Specific Protection
- No vaccine is available
- Early Diagnosis and Treatment
- Detected cases of sore throat( or acute pharyngitis )are treated by 1 dose
of 1.0 million units of Benzathine penicillin .This prevents the subsequent
development of Rh fever and RHD.
 STROKE

Definition
A stroke is a medical emergency and can cause permanent neurological
damage or death. caused by disturbance in the blood supply to the brain.
- This vascular disturbance can be due to ischemia caused by blockage
(thrombosis or embolism) or by hemorrhage, resulting in infarction of the
brain.
- Nearly 05 million people suffer from strokes every year.

Clinical feature
• characterized by sudden onset of
- unilateral paralysis
- loss of vision
- impairment of speech
- Convulsions
- coma or death.
• The effects of stroke are determined by the extent and site of brain injury. It
depends upon the area of the brain affected.
- If cerebrum is affected (hemiplegia, numbness, reduction in sensation)
- If brainstem is affected (involvement of cranial nerves)
- If cerebellum is affected (altered walking gait and vertigo)
- in hemorrhagic stroke: (Loss of consciousness, headache and vomiting)
because of increased intracranial pressure from leaking blood compressing
the brain.

Classification

I. Ischemic Stroke
• This the most common cause of stroke, %78.
• In this type, the blood supply to the brain is interrupted either by
arterial thrombosis, embolism, or systemic hypoperfusion (as in shock)

II. Hemorrhagic Stroke

• This results from rupture of a blood vessel or an abnormal vascular
structure (like aneurysm).
• Usually due to hypertension
Risk Factors
A. Non-modifiable risk factors:
- Age: Incidence after 05 years of age.
- Sex: more among men than among women in the rate of 7:1.
- genetic factors (family history).

B. Modifiable risk factors:

- Hypertension: the main risk factor. It accounts for 05 to 05 % of the cases.
- Hypercholesterolemia
- Atrial fibrillation
- arteriosclerosis
- disorders of blood coagulation
- Diabetes mellitus.
- Smoking & alcohol
- Oral contraceptive pills
- Drugs like cocaine and amphetamines
- Psychosocial stress & Physical inactivity & Obesity

Diagnosis
• Neurological examination
• CT scan & MRI
• Doppler/Ultrasound study of carotid artery
• Arteriography
• Blood test for cholesterol level

Prevention
I. Primary prevention
• Reduce risk factors
• increased consumption of fruits and vegetables
• low consumption of salt
• prevention of obesity, diabetes and hypertension.
• exercise, avoidance of smoking and alcohol.

II. Secondary prevention

• Early detection of stroke (slurring of speech, weakness in any limb)
• effective management

III. Tertiary prevention

• Rehabilitation of residual paralysis by physiotherapy, speech therapy.