Cardiovascular disease

Question 1

How does an atherosclerotic plaque form?

Answer 1

• chronic inflammation and activation of immune system in the artery wall
• deposition of lipids
• fibrous plaque forms

Question 2

What vessels are affected by atherosclerosis?

Answer 2

Medium and large blood vessels

Question 3

What is atherosclerosis?

Answer 3

atheroma - fatty deposits in artery walls

sclerosis - hardening of vessel wall

Question 4

What can atherosclerotic plaques cause?

Answer 4

1) Stiffening of wall leading to hypertension
2) Stenosis leading to reduced BF (angina)
3) Plaque rupture giving off thrombus, which can then cause ischaemia

Question 5

What are the modifiable risk factors of CV disease?

Answer 5

• smoking
• alcohol
• poor diet
• low exercise
• obesity
• poor sleep
• stress

Question 6

What are the non-modifiable risk factors of CV disease?

Answer 6

• Older age
• Family history
• Male

Question 7

What medical co-morbidities will increase risk of atherosclerosis?

Answer 7

• Diabetes
• Hypertension
• Chronic Kidney Disease
• Inflammatory conditions (e.g. rheumatoid arthritis)
• Atypical antipsychotics

Question 8

What are some of the end results atherosclerosis can cause?

Answer 8

• Angina
• MI
• Transient ischaemic attacks
• Stroke
• Peripheral vascular disease
• Mesenteric ischaemia

Question 9

What are primary and secondary prevention?

Answer 9

Primary - prevention for patients who’ve never had CV disease before
Secondary - Prevention for patients who have had CV disease before

Question 10

What are the methods of secondary prevention of CV disease?

Answer 10

1) Aspirin (+ second anti platelet e.g. clopidogrel)
2) Atorvastatin
3) Atenolol (usually bisoprolol to highest tolerated dose)
4) ACE inhibitor (usually ramipril to highest tolerated dose)

Question 11

What are the side effects of statins?

Answer 11

• Myopathy
• Type 2 Diabetes
• Hemorrhagic stroke (rare)

Question 12

What test should be done if a patient on statins complains of muscle weakness?

Answer 12

Creatine Kinase

Question 13

What are the methods of primary prevention?

Answer 13

• optimise modifiable risk factors

- Check Q-Risk and offer statin if applicable

Question 14

At what Q-risk score should patients be medicated and what medication should be given?

Answer 14

• Higher than 10%

- Given statin usually atorvastatin

Question 15

After putting patients on a statin what needs to be checked?

Answer 15

• Lipids at 3 months and adjust dose based on adherence
• aim for 40% reduction in non-HDL cholesterol
• Check LFTs within 3 months and at 12 months
• can cause rise in AST and ALT but unless 3x higher don’t need to be stopped

Question 16

What medication should patients who have had CKD or T1 Diabetes for more than 10 years be put on?

Answer 16

Atorvastatin