Flashcards in Cardiology Deck (287)
What are the two main disease processes in atherosclerosis
- Atheromatous plaque formation- Scarring and stiffenening of the aterial walls
What is the difference between atherosclerosis and arteriosclerosis
- Atherosclerosis affects the large and medium-sized arteries- Arteriosclerosis affects the smaller arterioles
What are the three main components to the aetiology of atherosclerosis
- Endothelial damage- Chronic inflammation- Activation of the immune system
What are the three main outcomes of untreated atherosclerosis
- Stiffening of the vessels walls leading to hypertension- Stenosis of the vessel walls causing stable angina and/or periperal vascular disease- Plaque rupture leading to thrombus formation and the development of an acute coronary syndrome
What are the non-modifiable risk factors of cardiovascular disease
- Age- Family history - Male sex
What are the modifiable risk factors for cardiovascular disease
- Smoking- Alcohol consumption- Poor diet - Lack of exercise- Poor sleep- Stress
Which co-morbidities can increase the risk of developing cardiovascular disease
- Diabetes (both T1DM and T2DM)- Hypertension- CKD- Inflammatory conditions (RA)- Atypical antipsycotics
Which conditions can cardiovascular disease lead to if left untreated
- Stable angina- Acute coronary syndromes (unstable angina, STEMI and NSTEMI)- Stroke- Transient ischaemic attack- Peripheral vascular disease- Chronic mesenteric ischaemia
What is the first port-of-call in the prevention of a patient developing cardiovascular disease
Optimise the modifiable risk factors - Inform patient about diet, excercise, smoking etc.- Optimise treatment for underlying co-morbidities
What is the difference between primary and secondary prevention of cardiovascular disease
Primary prevention - prevents CVD from developing in the first instanceSecondary prevention - prevents reoccurance and/or progression of cardiovascular disease following and ischaemic event
What is the most important step in the primary prevention of cardiovascular disease
Perform a Q-RISK3 score - a prediction of the likelihood of an ischaemic event over the next 10 years
If a patients' Q-RISK3 score is greater than 10, what does this mean
This means that there is a greater that 10% chance of the patient having an ischaemic event over the next 10 years
If a patients' Q-RISK3 score is greater than 10, what primary prevention is indicated
Q-RISK3 >10; commence atorvastatin (20mg) taken once a day at night
What dose of statin is indicated in the primary prevention of a patient with a Q-RISK3 score greater than 10?
How is the primary prevention of cardiovascular disease treatment different in patients with CKD or T1DM lasting greater than 10 years?
These patients should be started on atorvastatin 20mg regardless of Q-RISK3 score
What is the aim of statin treatment in the primary prevention of cardiovascular disease
To reduce non-HDL cholesterol by 40%
What monitoring is required in patients treated with a statin in the primary prevention of cardiovascular disease
3 monthly lipid profiling to ensure that a 40% reduction is acheived
What is the mainstay treatments given in the secondary prevention of cardiovascular disease
"The Four A's - Aspirin- Atorvastatin- Atenolol (or bisoprolol)- ACE-I (usually ramipril)"
What is the treatment dose of statin given to patients in the secondary prevention of cardiovascular disease
80mg (this is compared to 20mg in primary prevention)
What are the main side effects of statins?
- Myopathy - T2DM- Haemorrhagic stroke
A patient on statins presents with muscle ache and pains as well as weakness. What investigation should be carried out?
Creatine kinase blood test to look for rhabdomyolysis
What is meant by angina?
Angina refers to cardiac-related chest pain that occurs as a result of a narrowing of the coronary arteries that reduces the blood and oxygen supply to the myocardium
What is the difference between stable and unstable angina?
Stable angina - cardiac chest pain that only presents on exertion and which are relieved by GTN Unstable angina - cardiac chest pain that presents spontaneously at rest and occurs as a result of atheromatous plaque rupture
What are the symptoms of angina
Constricting chest pain +/- radiation to the jaw/left arm
What is the gold standard investigation for angina
CT coronary angiography
What investigations are most appropriate when investigating angina
- Physical exam- ECG; looking for old ischaemic changes, rule out PE and other causes of chest pain- FBC; looking for signs of anaemia- U&Es; indicating renal function prior to commencing ACE-I- LFTs; indicating liver function prior to commencing statin- Lipid profile; indicating modifiable risk factors and potential benefits of statin therapy - TFTs; hypo- and/or hyperthyroidism can be related to angina - HbA1C; looking for diabetes which is an optimisible disease risk factor
Outline the management techniques for angina
"Referral – to cardiology Advice – advise patient about diagnosis, management and when to Medical treatment – symptomatic relief and secondary prevention of subsequent cardiovascular disease Procedural/surgical treatment – either PCI or CABG"
What are the three main aims in the medical management of angina
- Immediate symptomatic relief- Further symptomatic prevention - Secondary prevention - Procedural/surgical intervention
Outline the immediate symptomatic relief strategies in the treatment of angina
GTN Spray - GTN + Rest (5mins) - No symptomatic relief --> repeat - Still no pain relief after repeat --> ambulance