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CVS > Clinical Aspects of Cardiovascular Risk > Flashcards

Clinical Aspects of Cardiovascular Risk Flashcards

1
Q

What is the most common form of premature death?

A

CHD

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2
Q

How prevalent is CHD?

A

No 1 cause of death worldwide No2 cause of death in developing countries

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3
Q

What is atherosclerosis?

A

A progressive disease characterised by plaque build-up in arteries.

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4
Q

What type of substances can form plaque?

A

Cholesterol, cellular waste, calcium, fibrin.

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5
Q

What can be the effect of a total/partial block of an artery due to atherosclerosis?

A
  • Bleeding into the plaque - Formation of blood clot in the artery. Can result in a stroke or heart attack
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6
Q

What is the pathophysiology of Atherosclerosis? (7)

A

Pathogenesis of Atherosclerosis:

  1. Endothelial damage
  2. Protective response causes production of cell adhesion molecules (IL-1, TNFa)
  3. Monocytes and T lymphocytes attach to the endothelial lining,
  4. Migrate through arterial wall into sub-endothelial space.
  5. Macrophages take up oxidised LDL-C
  6. Lipid rich foam cells
  7. Fatty streak and plaque
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7
Q

What are the effects of oxidised LDL formation?

A
  • Promotes death of endothelial cells and inflammatory response. - Produces thrombotic state by affecting platelets and coagulation factors. - Vasodilatory impairment.
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8
Q

What is athero-thrombosis? hows it caused?

A

Formation of an acute thrombus in a vessel that has atherosclerosis. -Plaque deposition may rupture, exposing the components of the endothelial such as collagen. - Platelets attach to the endothelium at the damaged site, causing an acute thrombus. - Thrombus formation can occlude the vessel, resulting in ischaemia or tissue injury. Can be fatal/non fatal.

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9
Q

What are some common risk factors for CVD? Mention non mod/ modifiable.

A

Non Modifiable: • Personal history of CHD • Family history • Age • Gender • Ethnicity Modifiable: • Smoking • Dyslipidaemia • Hypertension • Diabetes • Obesity • Alcohol • Lack of exercise.

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10
Q

What are the major classes of Lipoproteins?

A

• Chylomicrons • VLDL • Intermediate density lipoprotein • LDL • HDL

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11
Q

Which class of lipoprotein is the most dangerous? What are its risk factors?

A

LDL- Strongly associated with atherosclerosis and CVD. Modified by other risk factors: • Low HDL • Smoking • hypertension • Diabetes.

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12
Q

What problems are associated with high triglyceride levels?

A

Risk of CHD events. May have accompanying dyslipidaemias.

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13
Q

What is the effect of HDL on CHD?

A

Protective effect. Moves excess cholesterol in circulation to the liver for excretion. HDL levels- lowered by smoking, obesity, lack of exercise.

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14
Q

What are the effects of lowering Cholesterol?

A

Modifiable risk factor Reducing cholesterol levels reduces risk of CVD and total mortality. LDL-C: Main target of intervention in CVD.

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15
Q

What is primary prevention?

A

Long term reduction in cholesterol of 10% and measuring its benefits. In 40yr old men- 50% less risk of CVD 70yr old men- 20% less risk of CVD.

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16
Q

What is the main effect of statins?

A

Reduce total cholesterol and LDL cholesterol.

17
Q

What are some other beneficial effects of statins?

A

• Improvement of endothelial dysfunction • Increased NO bioavailability • Anti-oxidant properties • Inhibits inflammatory responses • Stabilises atherosclerotic plaques.

18
Q

What is the drug mechanism of statins?

A

Statins competitively inhibit HMG-CoA reductase, the rate limiting step in cholesterol synthesis. As a response, liver cells increase LDL receptor expression. More LDL cholesterol is removed rom the plasma and excreted by the liver.

19
Q

What are some of the clinical manifestations associated with high triglyceride levls levels?

A

Xanthomas: 1. Xanthelasma- Xanthoma in the eyelids. Swelled up areas around eyes. 2. Tendon xanthoma- Extensor tendons of fingers, patella, elbows, achillies tendon. Diffuse infiltration of tendon by lipid. 3. Tuberous xanthomas- Lipid deposits as papules, nodules or plaques at extensor surfaces of large joints, hands etc. Familial or acquired hypertriglyeridaemias. 4. Eruptive xanthomas- Small eruptive reddish yellow papules affecting buttocks, posterior thighs, body folds

20
Q

Name some common diseases in association with hypertension.

A

MI, LVH, CVD, Stroke, Aortic aneurysm, heart failure

21
Q

What are the two types of hypertension?

A
  • Essential: 90%. No underlying cause - Secondary: An underlying cause.
22
Q

What changes in the arteries are caused by high BP?

A
  • widen arteries, putting strain on the lining. - smooth muscle hypertrophy, narrowing lumen. - Fatty deposition on the endothelium can cause the lumen to get narrower.
23
Q

Is hypertension a risk factor for CHD?

A

Yes increased systolic and diastolic BP values increases risk of CHD.

24
Q

What are the effects of hypertension treatment?

A

Reduces BP. Other effects: Reduces ischaemic heart disease stroke mortality.

25
Q

What lifestyle modifications can help with hypertension?

A

Diet, exercise, stop smoking, lose weight, limit intake of salt and fatty food.

26
Q

What are the effects of diabetes on CVD?

A

Increases risk of various diseases like stroke, MI, CHD. Diabetes single risk factor is found to be more dangerous than the combined effects of hypertension, cholesterol and smoking.

27
Q

What is the main way to cure Obesity?

A

Controlling diet

28
Q

What types of food groups are good? (IMP REMEMBER THESE

A

-Micronutrients - omega 3,6 - antioxidants - polyunsaturates - monounsaturates

29
Q

What are the diseases caused by obesity?

A

Chronic conditions like stroke, angina, MI, hypertension, diabetes,

30
Q

What is the main way to counter obesity?

A
  • Diet - Exercise
31
Q

What is metabolic syndrome?

A

A cluster of conditions collectively termed as metabolic syndrome: - High BP - High blood sugar - Abnormal cholesterol/triglyceride levels - Excess body fat around waist.

32
Q

What is the usefulness of inflammatory markers as a predictor for CHD?

A

Studies showed that even having a high-normal CRP levels meant that risk of MI was significantly higher. Thus CRP can be used as a direct predictor of CHD.

33
Q

What major ethnic group are more likely to develop CVD?

A

South Asians. Black, caribbean, african much lower risk of CVD. greater risk of stroke however.

34
Q

What does Assign score do?

A

Uses risk factors, pmh, sh and fh to evaluate the risks of an individual getting CVD in the next ten years.

35
Q

What is the relevance of CVD risk in a person with multiple risk factors?

A

The sum of the different risk factors add up to impose a much greater risk than a single factor (even if the single factor is very sever)

36
Q

What are some common drug Types used to treat ischaemia?

A
  • Ca blocker - B blocker - Nitrates
37
Q

What are some common drug Types used to treat atherothrombosis?

A

-aspirin - statin - ACE - exercise - Smoking cessation.

CVS (21 decks)

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