Cardiology 1 - Cardiovascular Disease Flashcards
define athersclerosis
fatty deposits + inflammation in artery walls leading to stiffening
result of plaques in artery walls x3
stiffening and hypertension
stenosis and pain
rupture, thrombus + ischaemia
non-modifiable atherosclerosis risk factors x3
old age
family history
male gender
modifiable atherosclerosis risk factors x7
smoking alcohol intake poor diet low exercise obesity poor sleep stress
co-morbidities increasing atherosclerosis risk x5
diabetes hypertension chronic kidney disease inflammatory conditions (RA) atypical antipsychotics (end in -pine, -done or aripiprazole)
key risk factors in a cardiac history
exercise, diet, PMH, FH, occupation, smoking, alcohol intake, medications
6 end results of atherosclerosis
angina MI TIAs strokes peripheral vascular disease chronic mesenteric ischaemia
difference between primary and secondary prevention
primary have never had the disease, you are reducing the risk of occurence
secondary have had disease, you are reducing risk of relapse
give 4x ways of optimising your modifiable cardiac risk factors
advise on diet, smoking, weight loss
stop smoking
stop alcohol excess
treat comorbidities
2 x reasons for starting a statin in primary prevention
QRISK3 score of >10% in next 10 years
or 10 years living with type 1 diabetes or chronic kidney disease
start atorvastatin 20mg
process for starting a statin and treatment aim
check lipids 3 months afterwards
aiming for >40% reduction in non HDL lipids with good adherence
initial extra statin monitoring and why
when would you stop
also check LFTs at 3 months and again at 12 months
may cause transient ALT/AST rise
stop if > 3 x upper LFT limits
5 key components of secondary prevention in cardiovascular disease
aspirin 75mg clopidogrel 300mg then 75mg for 12 months atorvastatin 80mg atenolol 25mg or bisoprolol 10mg ramipril titrated to 10mg
3 key statin side effects
myopathy (check CK in patients with pain or weakness)
type 2 diabetes
rarely haemorrhagic stroke
other GP interventions following cardiovascular disease event
discuss concerns around return to work / exercise / driving
arrange left ventricular function assessment, assess bleeding risk, arrange cardio follow up for revascularisation surgery
