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M E " O R A N D U M To: From: Da~e: Re: All Subjective Coders Rebecca L. Benner February 24, 1988 Brown & W111~amson Tobacco Corp. Sub2ec~ve Codln@ Project Cardiovascular Disease Attached please f~nd an information sheet to be added to your coding manual. Please use this as a gulde to understanding at~erosclerosls. CC: R.L.B. Ernest J. Clements Lorl A. EubanKs Christopher M. George, Esq. Frederlck W. Mlehe, III Laura A. Owens, Esq. Dan H. Willoughby, Esq. Mark D. Wilson, Esq. J. Comer Yates, Esq.

PRIVILEGED AND CONFIDENTIAL ATTORNEY WORK PRODUCT CARDIOVASCULAR DISEASE plaque Dr] GLOSSARY Cardiovascular Disease (CVD): blood vessels of the body. (i) Atherosclerosis: disease pertaining to the hear- and Types of cardiovascular d:sease: (a) Atheroma: deposition of hard yellow plaaues of material in the inner (Intimal) layer the arteries. -!-

PRIVILEGED AND CONFIDENTIAL ATTORNEY WORK PRODUCT (b) Arteriosclerosis: degenerative change, a prlmary thickening of the middle (Med~a) coat of the vessel associated wltn advancing age. (2) Cardiomyopathy: acute, subacute, or chronic d~sorder of the heart muscle of obscure etiology, probably viral - not atherosclerot!c ~n origin. Chronic Obstructive Pulmonary Disease (COPD): lasting congested state especially in the aveoll of the lungs which is not directly associated with heart disease Out Is certainly a complicating factor therein. Coronary Artery Disease (CAD): atherosclerosls of the arteries on the heart (coronaries - same as Atherosclerotic Heart Disease (AHD) o Peripheral Vascular Disease (PVD): atherosclerosis of any artery other than a coronary artery - usually involves the aorta, the arteries of the legs, kidneys, and the carotids which lead to the brain. (NOTE: Patients with known PVD and no previous history of any cardiac symptcms are 90% likely to have CAD as well.) Myocardial Infarction (MI): development of an area of necrosis (tissue death) in the middle layer of the myocardium (heart muscle) due to cessation of blood supply due to the occlusion of a coronary artery - same as Heart Attack. Ischemia: local and temporary anemia (deficient oxygen exchange) due to obstruction of the clrcuiatlon to a part. Angina: sense of suffocation or constriction e.g. Angina Pectoris: pain and oppression about the heart characterized by severe pain radiating from the heart to the shoulder and down the left arm; dependent upon some les~on of the coronary arteries of the heart, its walls, or valves - same as Chest Pain. Hypertension (B'fN): high blood pressure, either systolic (tcp number) or diastzolic (bottom number). Left Ventricular Hyperthrophy (LVH): enlargement of the !eft ventricle of the heart caused by over-laboring of the heart muscle; frequently associated w~th and due to CAD and/or CAF - both conditions which lend to over-laboring as compensation. -2-

PRIVILEGED AND CONFIDENTIAL ATTORNEY WORK PRODUCT Congestive Heart Failure (C~{F): a chronic [nab~l~y of the heart to ma~ntaln an adequate output of blood from one or both ventricles, resultlng [n man~fest congestion (fluid buildup) and overdlstension of certain veins and organs w~tn blood, and thus an ~nadequate blood supply to the body tlssues. NH~POS IS (~centac~ loss of LVH ventrlcula~ contractllity (iarzer heart muscle r .equ~res more blood perfus~on) or e3ect~on fraction) heart m~scie's effort to co ~n~_nsate for d~reas~ e]~lon fra~lon) (fl~d bv~id-~xp ca~es o~'~rz press~e on _ Cne he~ ~scle) Vasoconstriction: acute narrowing of the lumen of the blood vessels causing hypertension, ~ncrease in heart rate, and diaphoresis (sweatlng). Vasodilation: Acute relaxation of the lumen of the blood vessels causzng hypotention (low blood pressure), a decrease or zncrease heart rate, and flushing. Tachycardia: fast heart rate Bradycardia: slow heart rate -3-

PRIV[LEGED AND CONFIDENTIAL ATTORNEY WORK PRODUCT Arrhythmia: irregular or "skipped" heart beats, i.e. premature atrial contractions (PAC), atrial or ventrlcular flbr~ilat~on (AFIB or VFIB), ventricular tachycardia (VTACH), bigem~ny (pulse of two beats followed by a pause before the next pa~r of beats), and trlgeminy (pulse of three beats followed by a pause before the next set of Beats). VTACH-> VFIB > DEATH! -4-

PRIVILEGED AND CONFIDENTIAL ATTORNEY WORK PRODUCT Risk Factors: "Risk" does not impIy cause-and-effect but rather is a "statlstical" predisposltlon to contracting a d~sease - not a functional biological characterlst:c. i Age - older >> younger 2 Sex - male >> female 3 Family History (Heredity) 4 Diabetes Mellltus (DM), Hyperglycemia 5 HypertenSion (HTN) 6 Stress 7 Diet 8 Obesity - 20 pounds overweight 9 Sedentary life style i0. Smokzng - causes Hypoxia ( [ ] 02 delivery by the [ ] C02, [.']CO, [] cyanide, or ~ypotenslon). angs due to