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ЗмістII. The goals of study.
2 type of Diabetes melli-tus or 1 type with microal-buminuria
Appendix 2.TARGET POPULATION
Table directions for use
Blood Pressure Control
Management of Total CVD – Blood Pressure
For patients with blood pressure
Antihypertensive Treatment: Preferred Drugs
Treatment Targets in Patients with Type 2 Diabetes
Three or more of the following risk factors indicate metabolic syndrome
In the majority of the countries of Europe cardiovascular diseases are the main reason of premature death. Besides, they serve as the important reasons of invalidity and growth of expenses for health protection.
Level of death from cardiovascular diseases depends on age, male, economical conditions, ethnic implements and geographic region.
If the importance of the subject is clear to you pass to study of the goals.
The general goal is to make primary and secondary prophylaxis of cardiovascular diseases.
1. Pick out groups of patients who need prophylactic measures to decrease risk of development and worsening of cardiovascular diseases.
2. Value general risk of cardiovascular events development.
3. Mark out modified and non-modified risk factors at the patient.
4. Devise prophylactic measures taking into account degree of detected risk factors.
5. Value compliance of the patients to recommendations and their efficiency.
You can find the information necessary for filling a gap in basic knowledge and skills in the following references:
Test 1. A woman 53 years old has been suffering from diabetes mellitus for 7 years She doesn’t smoke. At the estimation of general risk of fatal cardiovascular events the investigation of cholesterol level was prescribed. What purposeful level of cholesterol is needed for this patient?
A) < 3,8 mmol/l,
B) < 2,8 mmol/l,
C) < 4,5 mmol/l,
D) < 5,0 mmol/l ,
Test 2. You’ve examined a woman 50years old who has been suffering from diabetes mellitus for 8 years. What laboratory researches are not included in a list of estimation of fatal cardiovascular risk?
Test 3. On examination there is a patient of 35 years old, who does not smoke, BP is 125/70 mm HG. It is known that his relatives have had early appearing cardiovascular events. What research will you appoint to the patient for determination of necessity of cardiovascular events risk estimation?
A) blood coagulation
C) LE cells
Test 4. You are examining the patient with obesity of 2nd degree, diabetes mellitus and arterial hypertension of 2nd degree, 3rd stage. Which investigations are not included in the list of necessary ones for prognostication of risk of appearance of fatal cardiovascular events during 10 years?
4) general blood test
Test 5. Man 58 years, who lives in Greece has systolic BP 160 mm of Hg, cholesterol level is 5 mg/dl. How to value the 10year risk of fatal cardiovascular events by the scale of risk SCORE?
D) very high
Test 6. You’ve examined a man 62 years old. BWI is 28 kg/m2, circumference of waistline is 100 sm, BP is 120/80 mmHg. It is known that he smokes 40 years. Lab data: cholesterol level is 5,3 mmol/l, fasten glucose is 5,4 mmol/l. How many risk factors are take place in this case?
Test 7. You are examining the woman of 64 years old. Her level of BP is 170/90 mm HG, she smokes, cholesterol level is 4,0 mg/dl. She lives in Russia. How to value the 10year risk of fatal cardiovascular events by the scale of risk SCORE?
D) very high
Test 8. The examination of the patient G. of 62 years exposed that 10 year risk of fatal cardiovascular events is 5%. To which risk group does this patient belong?
A) very low
Test 9. You are examining the man of 42 years old, whose BP is 130|80 mm Hg. Due to modern classification of arterial hypertension specify the level of optimum blood pressure:
A) 130/80 mm Hg
B) 140/90 mm Hg
C) 125/80 mm Hg
D) 120/80 mm Hg
E) 135/70 mm Hg
IV. Subject Material
For achievement of goals of study it is necessary to master the following theoretical questions:
You can find the information necessary for study of the theoretical questions in the following references:
Break-down chart on the subject « Prevention of cardiovascular diseases»
Patients who need in examination
Anamnaesis about early appearance of cardiocascular diseases, hyperlypidemia
Wishing of the patient
Presence of 1 or more risk factors, high colesterol level
Smoker or patient of middle age
Presence of syptoms due to which you can suspect cardiocascular diseases
If cardiovascular diseases, diabetes mellites, marked risk factors are absent SCORE scale is used
Glucose level in urine
Protein in urine
Glucose level in blood
Creatinin level in blood
ECG at rest and exertional testing if angina is suspected
ECHO-CG at young patients and patients with high BP
Risk Score - <5% - advise healthy life-style, regular examinations in the future
Presense of marked 1 risk factor
Estimated cardiovascular disease
Risk at Score ≥ 5%
Recommendations about life style
If BWI≥25kg/м2, to become slimmer
To decrease weigth if waist linei is ≥ 88 sm in women and ≥102 sm in men
30-min of physical activity of middle intensity per day
(If risk by SCORE 5-10% or target-organs are affected)
If BP≥140/90 mm Hg, hypotensive therapy is prescribed
If holesterol level is ≥5 mmol/l or LDLP are ≥ 3 mmol/l, statins are indicated
If cardiovascular disease is present aspirin and statins are indicated
If diabetes mellitus prescribe drugs
1. If patient asks about examination
2. Patients with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease
Assessing Cardiovascular Risk: What Are the Components?
For an estimation of the general risk it is recommended to use system SCORE (Systematic Coronary Risk Evaluation - a regular estimation of coronary risk). It has been prepared on the basis of results the European researches and it allows predicting death risk from an atherosclerosis within 10 years. Criterion of high risk is the probability of death from cardiovascular complications of ≥5 % (instead of ≥20 % for total risk of coronary complications, as earlier). By means of system SCORE it is possible to develop the risk table of risk for all countries of Europe with allowance for corresponding figures of death rate.
(Systematic Coronary Risk Evaluation)
SCORECARD is an electronic variant of tables SCORE.
*Updated, recalibrated charts are now available for Belgium, Germany, Greece, the Netherlands, Poland, Spain and Sweden.
Risk estimation using the Systematic Coronary Risk Evaluation (SCORE) risk prediction system, considering age, gender, smoker status, systolic blood pressure, and cholesterol level
Risk Estimation Using SCORE: Qualifiers
Principles of Behaviour Change and Management of Behavioural Risk Factors
Goal Complete cessation. No exposure to environmental tobacco smoke.
Urge avoidance of exposure to environmental tobacco smoke at work and home
Goal: 30 minutes, 7 days per week (minimum 5 days per week)
Advise medically supervised programs for high-risk patients (e.g., recent acute coronary syndrome or revascularization, heart failure).
AHA 2006 Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction
Goal: Body mass index: 18.5 to 24.9 kg/m2
Waist circumference: men < 102 sm, women <80 sm
Classification of Arterial hypertension
Isolated systolic hypertension should be graded (1, 2, 3) according to systolic blood pressure values in the ranges indicated, provided that diastolic values are <90 mmHg. Grades 1, 2 and 3 correspond to a classification in mild, moderate and severe hypertension, respectively. These terms have now been omitted to avoid confusion with quantification of total cardiovascular risk.
<140/90 mm Hg
<130/80 mm Hg if patient has diabetes or chronic kidney disease
Mod = moderate; Rx = treatment
^ e >140/90 mm Hg (or >130/80 mm Hg for individuals with chronic kidney disease or diabetes):
Abbreviations: LVH: left ventricular hypertrophy; ISH: isolated systolic hypertension; ESRD: renal failure; ACEI: ACE inhibitors; ARB: angiotensin recepter antagonists; CA: calcium antagonists; BB: beta-blockers
Classification of Serum Lipids
Recommendations for healthy persons to prevent lipid pathology
For lipid management:
Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiate lipid-lowering medication as recommended below before discharge according to the following schedule:
Goal: Glycosylated hemoglobin (HbA1c) <7%
Diagnosis of Metabolic Syndrome ["Third Report," 2002]
Тест№1. To the patient who suffers from Arterial hypertension of the 2 degree, was recommended as one of the methods of prophylaxis cardiovascular risk of death physical activity. What level of it was indicated?
A) strict limitation of physical activity
B) 30 min low intensity physical activity a day
C) 15 min high intensity physical activity a day
D) 30 min mild intensity physical activity a day
E) 60 min low intensity physical activity a day
Тест№2. Patient E 68 years who suffers from Arterial hypertension of the 2 degree, 2 stage, has a high risk of cardiovascular events has come to the dietiterian. What diet will you recommend him with the purpose of decrease risk of fatal cardiovascular events?
A) unfatted sorts of fish, fruit, vegetables
B) products which are rich in iodine
C) limited sugar and carbonhydrates
D) pork, mutton
E) limited fluid intake
Тест№3. At objective examination of the patient Å. 46 years were observed vesicular breathing above lungs. Heart activity was normal. Heart rate was 68 per minute. BP was 160/90 mm HG. There were no edemas. Is it needed to begin medicament therapy with the purpose to decrease general risk of development of cardiovascular disorders?
B) no, it isn’t
C) yes, it is
D) only if cholesterol level is increased
E) only if level of fasten glucose increased
Тест№4. Patient D. complains of headache, frequent palpitation, lowering of work capacity. The examination exposed Heart rate of 100 beats a minute, BP 140 / 90 mm Hg. What doesn’t influence on the decision about prescription of medicamental treatment?
A) level of BP
B) existence of clinically exposed cardiovascular risk events
C) existence of other cardiovascular risk factors
D) existence of subclinic cardiovascular risk events or damage of target organs
E) existence of thyrotoxicosis
Тест № 5. The objective examination of 40-year-old woman who has been suffering from arterial hypertension for 15 years exposed that the circumference of waistline is 90 cm. What can you recommend her to improve her health?
A) control of body mass
B) body mass lowering
C) glucose restriction
D) change in diet is not needed
E) to heighten content of fat cultured milk foods in diet
Тест№6. What correction of general cardiovascular risk would you recommend to a patient of 48 years with arterial hypertension of the 2nd degree and cardiovascular risk 4% according to the SCORE?
A) change of life style
B) change of life style + medicamental therapy
C) medicamental therapy
D) in a case of arterial hypertension retention – medicamental therapy
E) possible medicamental therapy
Тест№7. A patient with arterial hypertension of the 1st degree and cardiovascular risk 8% according to SCORE is recommended medicamental therapy to bring down the general cardiovascular risk. What group of hypotensive medicines are not recommended as the 1st line for the treatment of such a patient?
B) Ca antagonists
C) α-adrenoceptors blockers
Тест№8. A patient with IHD, heightened level of general cholesterol were recommended medicines to bring down general cardiovascular risk. Which of the medicines can not bring down high cholesterol level?
C) sequestrants of fat acids
D) nicotinic acid
Тест№9. A patient with diabetes mellitus of the 2nd type is recommended to control the level of НВА1C regularly. What is the purpose level of it?
A) ≤ 3%
B) ≤ 4%
C) ≤ 5,5%
D) ≤ 6,5%
E) ≤ 6%
Тест№10. You are examining the patient M. of 56 years. The objective examination exposed that circumference of waistline is 98 cm. To confirm the diagnosis of Metabolic syndrome it’s necessary to perform several investigations. What of the following isn’t included in the list?
C) level of BP
D) level of fasten glucose
E) creatinine level
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