Atherosclerosis and Cardiovascular Disease Risk

Question 1

What do you need for atherosclerosis to begin?

Answer 1

Damage to the endothelium

Question 2

Risk factors for atherosclerosis?

Answer 2

a. Smoking
b. Dyslipidaemia
i. raised LDL cholesterol
ii. low HDL cholesterol
iii. raised triglycerides
c. Raised blood pressure
d. Diabetes mellitus
e. Obesity
f. Dietary factors
g. Thrombogenic factors
h. Lack of exercise
i. Excess alcohol consumption
j. Deprivation
k. Personal history
of CHD
l. Family history
of CHD
m. Age
n. Gender

Question 3

Difference between HDL and LDL?

Answer 3

HDL is good cholesterol and LDL is bad cholesterol

HDL cholesterol has a protective effect for risk of atherosclerosis and CHD

Question 4

Cholesterol metabolism?

Answer 4

Adipose tissue takes up Large VLDL and breaks it down.

LDL can then be taken up by LDL receptor in liver (best route) or modified by macrophage (want to avoid this route)

Question 5

What do statins do?

Answer 5

Inhibit part of the cholesterol synthesis pathway

Question 6

Signs of high cholesterol?

Answer 6

Xanthelasma- fatty deposits round the eye

Tendon xanthomas- extensor tendons of fingers, patella, elbows, achilles tendon

Tuberous xanthomas- lipid deposits in the dermis and subcutis; papuler, nodular or plaques; extensor surfaces of large joints, hands, buttocks, heels, flexures

Eruptive xanthomas- small reddish-yellow papules; buttocks, posterior thighs, body folds usually abrupt increase in serum triglyceride levels

Question 7

Difference between essential and secondary hypertension?

Answer 7

Essential- no underlying cause

Secondary Hypertension- underlying cause

Question 8

How does type 2 diabetes increase your risk of atherosclerosis?

Answer 8

Diabetes effects your coagulation, increases stickiness of the blood and makes vessel walls more rigid.

Question 9

What are the three main factors leading to thrombus (Virchow’s triangle)?

Answer 9

Alteration of blood flow
Damage to the endothelium of vessel
Changes in the Composition of blood

Question 10

Describe pathogenesis of atheroma?

Answer 10

1) Primary endothelial injury (due to smoking, hypertension, hyperlipidaemia etc.)
2) Accumulation of lipids and macrophages (increased LDL, reduced HDL, V-CAM, IL-1 and TNF expression)
3) Migration of smooth muscle cells
4) Increase in size

Question 11

When is atheromatous narrowing of an artery likely to produce critical disease?

Answer 11

• It is the only artery supplying an organ or tissue (i.e. There is no collateral circulation)
• The artery diameter is small (e.g coronary artery versus common iliac artery)
• Overall blood flow is reduced (i.e. cardiac failure)

Question 12

Describe arterial stenosis

Answer 12

There is narrowing of the arterial lumen resulting in reduced elasticity and reduced flow in systole, there will be tissue ischaemia resulting in angina, MI or heart failure due to cardiac fibrosis.

Question 13

Describe thrombosis

Answer 13

This will block arteries and cause infarction

Question 14

What is an aneurysm

Answer 14

Abnormal and persistent dilatation of an artery due to a weakness in its wall

Question 15

Types of aneurysm

Answer 15

MAD CATS

Mycotic (Septic emboli), atherosclerotic, dissecting, congenital, arteriovenous, traumatic, syphilitic

Question 16

Most common site of aneurysm is…

Answer 16

The abdominal aorta

Question 17

Complications of aneurysm rupture?

Answer 17

Rupture, thrombosis, embolism, pressure erosion of adjacent structures and infection.

Question 18

What is arterial dissection?

Answer 18

Splitting within the media by flowing blood creating a false lumen filled with blood in the media. This can form blood clots or block flow.

Question 19

Other than atheroma what else can cause arterial dissection?

Answer 19

Hypertension, trauma, coarctation (congenital narrowing of the aorta), marfan’s and pregnancy.

Question 20

In secondary hypertension underlying diseases could be?

Answer 20

1) Renal disease
2) Endocrine disease
• Adrenal gland hyperfunction / tumours
• Conn’s syndrome - excess Aldosterone
• Cushing’s syndrome - excess corticosteroid
• Phaeochromocytoma - excess noradrenaline
3) Aortic disease
4) Renal artery stenosis
5) Drug therapy

Question 21

Left ventricular hypertrophy is related to _____1_____ you could tell if this had occurred by palpating the ____2____

Answer 21

hypertension

apex beat

Question 22

The presence of a fourth heart sound may be indicative of …

Answer 22

left ventricular stress a feature of hypertension

Question 23

Define the different stages of hypertension

Answer 23

Stage 1: Clinic BP of 140/90 and ABPM or daytime average of 135/85

Stage 2: Clinic BP 160/100 mmHg or higher and ABPM or HBPM daytime average is 150/95 mmHg
or higher.

Severe Hypertension: Clinic BP is 180 mmHg or higher or Clinic diastolic BP is 120 mmHg or higher.

Question 24

Complications of hypertension?

Answer 24

Risk factor for stroke
Impaired vision- hypertensive retinopathy
Risk for MI and congestive heart failure
Causes end stage kidney disease
Accelerates atherosclerosis
Risk of aortic aneurysm and therefore rupture

Question 25

How is hypertension treated?

Answer 25

Lifestyle advice

Medication
For under 55s (not fertile women)
ACE / ARB then add calcium channel blockers then diuretics

For over 55s or those of african american descent start with calcium channel blockers, then add ACE/ ARBs then diuretics

Question 26

Offer antihypertensive drug treatment to those in stage one and under 80 that ?

Answer 26

ONE OF:
target organ damage
established cardiovascular disease
renal disease
diabetes
a 10-year cardiovascular risk equivalent to 20% or greater.

Question 27

Offer antihypertensive drugs for those with stage 2 or above to?

Answer 27

Everyone

Question 28

How often should reviews be for hypertension?

Answer 28

Annually