Cardiology

Question 1

What is atherosclerosis

Answer 1

A disease of medium and large arteries
Chronic inflammatory response with an accumulation of lipid laden macrophages and proliferation of vascular smooth muscle cells. Plaque formation.
Thrombosis leads to acute vascular events

Question 2

Stages of plaque formation

Answer 2

1. Fatty streak
2. Fibrous cap
3. Lipid core

Question 3

What are the types of lipid in plasma?

Answer 3

1. Cholesterol
2. Triacylglycerol (triglycerides)
3. Phospholipid

Question 4

What are the signs of Hyperlipidemia?

Answer 4

1. Tendon Xanthoma
2. Xanthelasmata
3. Corneal arcus

Question 5

How to treat hyperlipidemia?

Answer 5

Diet
Simvastatin (statins)
Fibrates
Cholesterol uptake inhibitors (Ezetimibe)

Question 6

Simvastatin

Answer 6

Specific, reversible, competitive HMG-CoA reductase inhibitors. Stops cholesterol synthesis (mevalonate).
SE: Myalgia, GI disturbance, Increased liver enzymes (AST), insomnia, rash.

Question 7

Fibrates

Answer 7

Stimulate Lipoprotein Lipase. Lowers LDL, VLDL and Raises HDL.
Not shown outcome effectiveness
SE: GI upset

Question 8

Medications used in coronary artery disease

Answer 8

Nitrates
Beta blockers
Calcium antagonists
Potassium channel activators
Statins
Antiplatelet agents
ACE Inhibitors, diuretics,

Question 9

Who to treat with hypertension?

Answer 9

Everyone > 160/100 mmHg and for those > 140/90 mmHg with significant risk factors of coronary events (Diabetes or end organ damage).

Question 10

Causes of hypertension?

Answer 10

1. ISH (Isolate systolic hypertension) most common, and from stiffening of large arteries (arteriosclerosis).
2. Malignant or accelerated - rapid rise in bp, leading to vascular damage, typical > 200/130. Headache + visual disturbance.
3. Essential hypertension - (primary cause unknown) Small arteries. Increase CO/ peripheral resistance
4. Secondary hypertension - renal disease, endocrine disease (cushing’s and conn’s syndromes, phaeo, acromegaly, hyperparathyroidism), Others (Coarctation, pregnancy, steriods, the Pill)

Question 11

Treating hypertension

Answer 11

1. Lifestyle changes
2. Drugs
   Monotherapy - 1st line > 55yr or Black Ca channel blocker or thiazide. If < 55yr ACEi or ARB if intolerant.
   Beta blockers not first line but consider in young, intolerance, child bearing potential or increased sympathetic drive.
   Combination - ACEi + Ca channel blocker or diuretic

Question 12

Chlortalidone

Answer 12

Thiazide diuretic, Act on the distal tubule. Bind to Cl- site of Na+/Cl- co transporter. Inhibiting its action. Causing natriuresis

Question 13

Nifedipine

Answer 13

Dihydropyridine Ca channel blocker, primarily blocks L-type calcium channels. Antianginal and antihypertensive

Question 14

Lisinopril

Answer 14

Angiotensin converting enzyme, not metabolised by the liver. Blocks production of angiotensin II thus lower arteriolar resistance and increase venous capacity. Increases Natriuresis.

Question 15

Candesartan

Answer 15

Angiotensin II receptor blocker, AT1 receptor antagonist.

Question 16

Angina

Answer 16

Narrowing of coronary arteries. Discomfort on exertion, eased by rest in minutes. Reversible
Not a pain, an ache. Often some associated SOB.

Question 17

Heart attack, ACS

Answer 17

Blockage due to clot usually on narrowing, discomfort at rest > 15 - 30 mins waxes and wanes. Sweating and unwell. Muscle damage occurs, life threatening.

Question 18

Location of Angina

Answer 18

Anywhere!! Typical retrosternal. Radiation in lower jaw and arms (non specific)

Question 19

Unstable angina clinical presentation

Answer 19

Symptoms on exertion BUT provoked at lower levels and sometimes persistent at rest. Diaphoretic.

Question 20

In patients unable to exercise for a stress ECG what is given?

Answer 20

Dobutamine is used as a chemical stressor