Cardiovascular disease (CVD)

Question 1

1) What is atherosclerosis?
2) What does chronic inflammation lead to, that results in the development of an atherosclerotic lesions (5)?
3) What is the earliest visible lesion in the pathogenesis of CVD?
4) This is formed due to the accumulation of what cells?
5) What are the 3 major components of atherosclerotic lesions?
6) What are the 3 consequences/potential consequences of atherosclerotic lesions?

Answer 1

1) Combination of atheroma (fatty deposits in the artery walls) and sclerosis (hardening or stiffening of blood vessel walls) that affects medium to large arteries
2) Cytokine release, smooth muscle cell proliferation, connective tissue matrix synthesis and accumulation of macrophages and lipids
3) Fatty streak
4) Foam cells (lipid laden macrophages)
5) Cellular component (SM + macrophages), CT matrix + extracellular lipids, intracellular lipids that accumulate within macrophages
6) Stiffening, stenosis, potential plaque rupture

Question 2

Risk factors
1) Name a modifiable risk factor
2) Name a non-modifiable risk factor
3) Name a comorbidity that is a risk factor

Answer 2

1) Smoking, poor diet, low activity levels and exercise, obesity, poor sleep and stress, excessive alcohol consumption
2) Age, ethnicity, sex, family history
3) Hypertension, diabetes, CKD, rheumatoid arthritis

Question 3

Name 3 symptoms of CVD

Answer 3

• Chest pain
• Pain, weakness or numbness in the arms or legs
• Breathlessness
• Fast or slow heartbeat, or palpitations
• Dizziness, lightheadedness, feeling faint
• Fatigue
• Swollen limbs

Question 4

Name 2 potential complications of CVD

Answer 4

• Angina
• Acute coronary syndrome/MI
• Stroke and TIAs
• Peripheral vascular disease

Question 5

What is the difference between primary and secondary prevention in CVD?

Answer 5

Primary prevention is for patients that have never had CVD in the past, and secondary prevention is for patients that have had one of the complications of CVD

Question 6

Primary prevention of CVD
1) What does the QRISK 3 score calculate?
2) If the QRISK score is > 10%, what should be prescribed?
3) All patients with CKD or T1DM for more than 10 years should be offered what drug?
4) Why do LFTs have to be done at 3 months and 12 months in patients started on this drug?
5) In what scenario would the result of this test result in the drug being stopped?

Answer 6

1) Calculates percentage risk that a patient will have a stroke or a MI in the next 10 years
2) Statin i.e. atorvastatin
3) Atorvastatin
4) Statins can cause a mild rise in ALT and AST in 1st few weeks of use
5) ALT and AST rise is > 3 times the upper limit of normal

Question 7

What are the 4A’s in CVD secondary prevention?

Answer 7

• Aspirin + a second antiplatelet
• Atorvastatin
• Atenolol (or another beta blocker)
• ACE inhibitor