Cardiovascular Flashcards
What does primary prevention of CVD involve?
-Free health check every 5 years for anyone 40-74 years (not already diagnosed with CVD)
-Includes:
–CVD risk assessment
–Alcohol consumption assessment
–Physical activity assessment
–Cholesterol level
–BMI
–Dementia assessment for 65-74s
–Diabetes / CKD screening for those at increases risk
When is the Q-RISK tool used?
-Assesses the risk of an individual developing CVD using calculation of risk factors
-Consider using it in those considered high risk or with conditions such as diabetes or CKD
-Calculates a 10-year estimated risk
How should Q-RISK results be interpreted?
-Expressed as a percentage estimated risk of developing CVD within next 10 years
-For those with 10% or less –> offer lifestyle advice and review in 5 years
-For those with >10%:
–Offer statin treatment after lifestyle modification (Atorvastatin 20mg)
–Offer atorvastatin 80mg in established disease ie for secondary prevention
When should anti-platelet therapy be prescribed in secondary prevention of CVD?
In those with:
-ACS
-Angina
-AF
-Peripheral arterial disease
Or after:
-MI
-Stent implantation
-Stroke / TIA
Which anti platelets are first-line treatment for angina / AF / ACS / stroke / PAD?
-Angina = aspirin 75mg (clopidogrel if not tolerated)
-AF = warfarin / doac (20mg) OR aspirin 75mg + clopidogrel 75mg if doac not tolerated
-ACS = aspirin 75mg + ticagrelor 90mg BD for 1 year
-Stroke / TIA = clopidogrel 75mg
-PAD = clopidogrel 75mg
What is the advice for driving post-MI / stroke?
-If no angioplasty - cannot drive for 4 weeks
-If angioplasty - cannot drive for 1 week
-Post-stroke / TIA - cannot drive for 4 weeks and must inform DVLA
What are the New York Heart Association’s classifications of heart failure?
Class I = no limitation of physical activity, ordinary function does not cause fatigue, palpitations or SOB
Class II = slight limitation of physical activity, comfortable at rest but ordinary function results in above symptoms
Class III = marked limitation of physical activity, comfortable at rest but less than ordinary function results in symptoms
Class IV = unable to carry out physical activity without discomfort, symptoms present at rest
How should HF with reduced ejection fraction (ie systolic) be managed?
-Stop drugs that may worsen HF if possible
-Loop diuretic to improve symptoms (furosemide 20-40mg)
-ACEi (lisinopril, enalapril, NOT rampiril) and BB (bisoprolol), commencing one at a time
-Consider anti-platelet or statin therapy
-Consider cardio rehab
-Ensure has up-to-date vaccines
How should HF with preserved ejection fraction (ie diastolic) be managed?
-Stop drugs that may worsen HF if possible
-Loop diuretic to relieve symptoms
-Consider anti-platelet or statin therapy
How should someone with a suspected TIA be managed?
-ROSIER score to assess likelihood of stroke
-Within last week –> give aspirin 300mg (if not already on anticoagulant / anti platelet) + refer for specialist assessment
-Over 1 week ago –> refer for specialist assessment within 7 days
What is the recommended long-term management post-stroke?
-Inform DVLA and cannot drive for 1 month
-Lifestyle advice
-Clopidogrel 75mg or doac if have AF
-Atorvastatin 20-80mg
-Anti-hypertensives if appropriate
What should be checked at an annual hypertension review?
-BP
-Renal function (U+Es, eGFR, ACR)
-Urine dip
-QRISK score for those not on antiplatelet / statin therapy
How is AF defined?
-Paroxysmal = episodes lasting >30 seconds but less than 7 days, episodes are terminating and recurrent
-Persistent = episodes lasting longer than 7 days, or requiring pharmacological / electrical cardioversion
-Permanent = fails to terminate using cardioversion / relapses within 24 hours
How should AF be managed in primary care?
-Prescribe drugs with the aim or preventing complications and alleviating symptoms
-Consider risk of bleeding when commencing anticoagulation (CHADSVASC and ORBIT bleeding score)
-Start doac / warfarin 20mg
-BB or CCB recommended, digoxin for non-paroxysmal sedentary patients
-Inform DVLA
What does the CHA2DS2VASc score denote?
-Congestive heart failure (ie systolic)
-Hypertension
-Age >75 = 2
-Diabetes
-Stroke / TIA = 2
-Vascular disease
-Age 65-74
-Sex category (female)
