Cardiology - Cardiovascular Disease

Question 1

What is atherosclerosis?

Answer 1

A combination of atheroma formation (fatty deposits in the artery walls) and sclerosis (stiffening of the blood vessel walls).

Atherosclerosis affects the medium and large arteries, caused by chronic inflammation and activation of the immune system to cause the deposition of lipids in the artery wall, followed by the development of fibrous atheromatous plaques.

Question 2

Outline the three main consequences atherosclerotic plaques cause.

Answer 2

• stiffening: causes hypertension and strain on the heart as it tries to pump blood against extra resistance.
• stenosis: leads to reduced blood flow (e.g. precipitating angina)
• plaque rupture: creates a thrombus that can block a distal vessel and cause ischaemia (e.g. acute coronary syndromes)

Question 3

Give the risk factors for cardiovascular disease.

Answer 3

• increasing age
• family history
• male sex
• hypercholesterolaemia
• smoking
• alcohol consumption
• poor diet
• lack of exercise
• obesity
• poor sleep
• stress

Question 4

Give some medical co-morbidities that increase the risk of cardiovascular disease.

Answer 4

• diabetes
• hypertension
• chronic kidney disease
• rheumatoid arthritis
• atypical antipyschotic medications

Question 5

What are the end results of atherosclerosis?

Answer 5

See image

Question 6

What is meant by

a) primary prevention of cardiovascular disease?

b) secondary prevention of cardiovascular disease?

Answer 6

a) prevention for patients that have never had a diagnosis of CVD

b) prevention for patients after a diagnosis of angina, myocardial infarction, TIA, stroke or peripheral arterial disease.

Question 7

What lifestyle changes can be introduced to control cardiovascular disease?

Answer 7

• address diet, exercise and obesity
• smoking cessation
• reduce alcohol consumption
• optimise treatment of co-morbidities

Question 8

The NICE guidelines (February 2023) on cardiovascular disease recommend which dietary changes?

Answer 8

• total fat <30% of total calories
• reduced sugar intake
• 5 a day of fruit and vegetables
• 2 a week of fish
• 4 a week of legumes, seeds and nuts

Question 9

The NICE guidelines (February 2023) on cardiovascular disease recommend what level of physical activity?

Answer 9

• aerobic activity for 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) per week
• strength training activities at least 2 days per week

Question 10

Describe the primary prevention of cardiovascular disease.

Answer 10

Medication for primary prevention based upon QRISK3 score.

NICE guidelines (February, 2023) recommend that if QRISK3 > 10%, patients are offered atorvastatin 20mg OD.

Atorvastatin 20mg OD also offered as primary prevention in all patients with CKD, and patients with T1DM over 40yrs.

Question 11

Describe the secondary prevention of cardiovascular disease.

Answer 11

4A’s mnemonic:

• antiplatelet medication (e.g. clopidogrel)
• atorvastatin 80mg OD
• atenolol (titrated to maximum tolerated dose)
• ACEi (ramipril)

Question 12

What is familial hypercholesterolaemia?

Answer 12

An autosomal dominant genetic condition causing elevated cholesterol levels.

Important features to remember:
- family history of premature cardiovascular disease
- very high cholesterol (>7.5mmol/L)
- tendon xanthomata

Question 13

What is the management of familial hypercholesterolaemia?

Answer 13

• specialist referral for genetic testing
• statin therapy