Cardiology Flashcards
What is atherosclerosis?
A combination of fatty deposits (plaque) in the artery walls and the hardening of the walls
Which blood vessels does atherosclerosis affect?
The medium and large arteries
What causes atherosclerosis?
Chronic inflammation and activation of the immune system in the artery wall.
What can atherosclerotic plaques cause?
Stiffening of artery walls–> leading to hypertension
Stenosis–> reduced blood flow (angina)
Plaque rupture–> may give off a thrombus that leads to ischeamia
What are the non-modifiable risk factors for athersclerosis?
Age
Family history
Male
What are the modifiable risk factors?
Smoking Alcohol consumption Poor diet Low exercise Obesity Poor sleep Stress
What co-morbidities increase the risk of atherosclerosis?
Diabetes Hypertension Chronic kidney disease Inflammatory conditions Atypical antipsychotic medication
What are the end results of atherosclerosis?
Angina MI Transient ischaemic attacks Stroke Peripheral vascular disease Mesenteric ischaemia
What is secondary prevention of cardiovascular disease?
Trying to prevent another attack in those who have had angina, MI, TIA, stroke or peripheral vascular disease
What algorithm calculates the percentage risk of a patient having cardiovascular disease in the next 10 years?
QRISK 3 score
What should happen if a patient has a >10% risk of stroke/ heart attack in the next 10 years according to their QRISK 3 score?
They should be offered a statin (e.g. atorvastatin 20mg)
Who other than those identified at risk should be offered a statin?
Patients with chronic kidney disease of Type 1 diabetes for >10 years
What are the 4 A’s of secondary cardiovascular disease prevention?
Aspirin
Atorvastatin (80mg)
Atenolol (or other beta-block)
ACE0 inhibitor
What are the main side effects of statins?
Myopathy
Type 2 diabetes
Heamorrhagic strokes
What is angina?
A narrowing of the coronary arteries, reducing blood flow to the myocardium
What are the main symptoms of angina?
Constricting chest pain
Radiating pain to jaw or arms
(usually worse during times of high demand e.g. exercise)
When is angina classed as ‘stable’?
When symptoms are always relieved by rest or GTN.
When is angina unstable?
When the symptoms come on randomly while at rest (ACUTE CORONARY SYNDROME)
What are the main investigations into angina?
CT Coronary Angiography Physical exam ECG FBC, U&E's LFTs Lipid profile Thyroid function tests and HbA1C
What is CT coronary angiography?
Contrast is injected and CT images are taken in time with the heart beat to give a detailed view of the coronary arteries.
What are the four principles of management of angina?
RAMP Refer to cardiology Advise them about diagnosis and management Medical treatment Procedural or surgical interventions
What are the three main aims to medical management of angina?
Immediate symptomatic relief
Long term symptomatic relief
Secondary prevention of cardiovascular disease
What is used for immediate symptomatic relief of stable angina?
GTN spray (take it then repeat after 5 minutes. If pain persists, call ambulance)
What does GTN spray do?
Causes vasodilation to help relieve symptoms of angina.