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FinalMB Part I - Medicine > Cardiology > Flashcards

Flashcards in Cardiology Deck (287)
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1

What are the two main disease processes in atherosclerosis

- Atheromatous plaque formation
- Scarring and stiffenening of the aterial walls

2

What is the difference between atherosclerosis and arteriosclerosis

- Atherosclerosis affects the large and medium-sized arteries
- Arteriosclerosis affects the smaller arterioles 

3

What are the three main components to the aetiology of atherosclerosis

- Endothelial damage
- Chronic inflammation
- Activation of the immune system

4

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 

5

What are the non-modifiable risk factors of cardiovascular disease 

- Age
- Family history 
- Male sex

6

What are the modifiable risk factors for cardiovascular disease

- Smoking
- Alcohol consumption
- Poor diet 
- Lack of exercise
- Poor sleep
- Stress

7

Which co-morbidities can increase the risk of developing cardiovascular disease

- Diabetes (both T1DM and T2DM)
- Hypertension
- CKD
- Inflammatory conditions (RA)
- Atypical antipsycotics 

8

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

9

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

10

What is the difference between primary and secondary prevention of cardiovascular disease

Primary prevention - prevents CVD from developing in the first instance
Secondary prevention - prevents reoccurance and/or progression of cardiovascular disease following and ischaemic event

11

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 

12

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 

13

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 

14

What dose of statin is indicated in the primary prevention of a patient with a Q-RISK3 score greater than 10?

20mg

15

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

16

What is the aim of statin treatment in the primary prevention of cardiovascular disease

To reduce non-HDL cholesterol by 40% 

17

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

18

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)
"

19

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)

20

What are the main side effects of statins?

- Myopathy 
- T2DM
- Haemorrhagic stroke

21

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 

22

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

23

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

24

What are the symptoms of angina

Constricting chest pain +/- radiation to the jaw/left arm

25

What is the gold standard investigation for angina

CT coronary angiography 

26

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 

27

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
"

28

What are the three main aims in the medical management of angina

- Immediate symptomatic relief
- Further symptomatic prevention 
- Secondary prevention 
- Procedural/surgical intervention 

29

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 

30

Outline the further symptomatic prevention strategies in the treatment of angina

"- β-blocker (bisoprolol or atenolol, 5mg) OR Ca2+ channel blocker (amlodipine, 5mg) 
- Combine β-blocker AND CCB if symptoms persist 
- Further persistance 
   o Long-acting nitrates - isosorbide mononitrate 
   o Funny current (If) blockers - ivabradine 
   o K+ channel activators - nicorandil (also NO donor) 
   o Late Na+ current blockers - ranolazine 
"