Cardio - NYHA And Statins

Question 1

Outline NYHA class 1 description

Answer 1

• No symptoms

- no limitation: ordinary physical exercise does not cause undue fatigue, dyspnea or palpitations

Question 2

Outline NYHA class 2 description

Answer 2

• Mild symptoms
• Slight limitation of physical activity: comfortable at rest but ordinary activities result in fatigue, palpitations or dyspnea

Question 3

Outline NYHA class 3 description

Answer 3

• Moderate symptoms

- marked limitation in physical activity: comfortable at rest but less than ordinary activity results in symptoms

Question 4

Outline NYHA class 4 description

Answer 4

• Severe symptoms
• Unable to carry out any physical activity without discomfort: symptoms of HF are present even at rest with increased discomfort and with any physical activity

Question 5

What is the MOA of a statin?

Answer 5

-Inhibit action of HMG-CoA reductase - rate limiting enzyme in hepatic cholesterol synthesis

Question 6

What are the adverse S/Es of statins

Answer 6

• Myopathy: myalgia, myosotis, rhabdo, asymptomatic Raised CK
• Liver impairment
• May increase risk of intracerebral haemorrhage in pts who have previously had a stroke - Royal college physicians recommend avoiding statins in pts with Hx of intracerebral haemorrhage

Question 7

What monitoring do you need for a statin? What do you do if it is elevated?

Answer 7

• LFT: baseline, 3 month and 12 months

- Discontinue if serum transaminase concentrations rise and persist at 3x upper limit of ref range

Question 8

What pts should receive a statin? 4 prompts

Answer 8

• All people with established CVS disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
• Anyone with 10 year CVS (QRISK) score >= 10%
• Patients with T2DM should always be assessed for QRISK
• Pts with T1DM who were diagnoses >10 years ago OR are aged over 40 OR have established neuropathy

Question 9

What is classed as primary prevention? What dose of statin do you give?

Answer 9

• 10 year QRISK >= 10 OR most type 1 OR CKD if eGFR <60

- Give atorvastatin 20mg OD (if non-HDL cholesterol hasn’t by >= 40%, consider titration up to 80mg)

Question 10

What is classed as secondary prevention? What dose is this?

Answer 10

• Known ischaemic heart disease OR cerebrovascular disease or peripheral arterial disease
• Atorvastatin 80mg OD