Cardiovascular Disease

Question 1

What is atherosclerosis?

Answer 1

The build-up of plaque within arteries

Question 2

What can form a plaque within arteries?

Answer 2

• Fatty substances
• Cholesterol
• Cellular waste
• Calcium
• Fibrin

Question 3

Why is atherosclerosis of concern?

Answer 3

It decreases the lumen of arteries which may lead to an MI, stroke or other ischaemia due to partial or complete vessel occulsion

Question 4

What are the stages in the formation of atherosclerotic plaques?

Answer 4

• Endothelial damage
• Production of cellular adhesion molecules
• Monocytes and T cells attach to the surface of endothelial cells
• Diapedesis occurs through artery walls into sub-endothelial space
• Macrophages take up oxidised LDL-C
• They then form lipid-rich foam cells
• Formation of a fatty streak (and plaque) occurs due to deposition of foam cells

Question 5

What is atherothrombosis?

Answer 5

A term used to describe an acute thrombus in a vessel affected by atherosclerosis

Question 6

Why do platelets adhere to the damaged area after an atherosclerotic plaque ruptures?

Answer 6

The contents of the atherosclerotic plaque (including collagen and von Willebrand factors) are released causing the adherence

Question 7

What are risk factors for develping an atherosclerosis?

Answer 7

• Inactivity
• Age
• Heart disease and diabetes
• Hypertension
• Alcohol and smoking
• Obesity and eating unhealthy

Question 8

What is the most atherosclerotic lipoprotein?

Answer 8

Low-density lipoprotein (LDL)

Question 9

Which lipoprotein does not affect atherosclerosis at all?

Answer 9

High density lipoprotein (HDL)

(protects against it)

Question 10

What would be considered high triglyceride levels?

Answer 10

4.5-11.3mmol/l

(normal is around 2.3mmol/l)

Question 11

What is the difference between absolute and relative risk?

Answer 11

• Absolute - the likelihood of of developing disease when considering the whole population’s averge risk
• Relative - the likelihood of developing a disease when taking into consideration your risk factors compared to those of others

Question 12

Which enzyme does the statin drug class inhibit?

Answer 12

HMG-CoA reductase

Question 13

Give 2 examples of statins

Answer 13

1. Simvastatin
2. Lovastatin

Question 14

Xanthelasma is a sign of what?

Answer 14

Hyperlipidaemia

(raised serum levels of total cholesterol or LDL-C)

Question 15

Where do tendon xanthomas affect?

Answer 15

Tendons of fingers, patella, elbows and Achilles

Question 16

Tuberous xanthomas affect where in the body?

Answer 16

Forms nodules, papules or plaques

Affects extensor surface of large joints, hands, buttocks, heels and flexures

Question 17

What are the two types of hypertension?

Answer 17

1. Essential - idiopathic (primary)
2. Secondary - as a result of a co-morbidity

Question 18

Why does hypertension have increased risk of atherosclerosis?

Answer 18

More damage is done to blood vessels

Hypertension causes widening of arteries due to pressure

The artery walls thicken in response narrowing the lumen

This mean plaques can build up easier in the more enclosed space

Question 19

Which diet is associated with higher survival rates after MI?

Answer 19

Mediterranean

Question 20

Fasting glucose should not be above which level?

Answer 20

>=5.6mmol/l

Question 21

When treating atherosclerosis, which two branches of the disease can be targeted?

Answer 21

Ischaemia - anti-anginal medication, revascularisation

Atherothrombosis - aspirin, statin, beta blocker, ACEI, smoking cessation etc.