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Case 4 > Clinical Risk Factors for Ischaemic Heart Disease > Flashcards

Clinical Risk Factors for Ischaemic Heart Disease Flashcards

1
Q

Outline the anatomical considerations of coronary arteries

A

Myocardial blood supply arises from the aorta via coronary sinuses. There are 3 principle epicardial sinuses: right coronary artery, left anterioir descending artery and circumflex artery.

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2
Q

When does coronary blood flow

A

During diastole

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3
Q

What is ischaemic heart disease

A

An inequality between myocardium oxygen supply and demand

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4
Q

What is aortic stenosis

A

Damage to the biscupid valve

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5
Q

Explain how aortic stenosis can be due to rheumatic heart disease

A

Damage to the valve from rheumatic fever causes increased turbulence across the valve

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6
Q

What does tachydysrhythmia result in

A

Decreases blood flow to the coronary arterties

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7
Q

What is beri-beri disease caused by

A

Thiamine deficiency, thiamine (vitamin B1) is known as thiamine pyrophosphate in its biologically active form and plays a critical role in carbohydrate metabolism and produces essential glucoses for energy by acting as a coenzyme. Thiamine is related to the biosynthesis of neurotransmitters and the production of substances used in defence against oxidant stress. A lack of thiamine can cause cardiac insufficiency

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8
Q

What is the vast majority of ischaemic heart disease caused by

A

Atherosclerosis

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9
Q

What may contribute to the initial endothelial dysfunction or ‘injury’ in atherosclerosis

A

Mechanical shear stresses (e.g. from morbid hypertension), biochemical abnormalities (e.g. from elevated LDL, diabetes mellitus), immunological factors (e.g. free radicals from smoking), inflammation (e.g. infection such Chlamydophila pneumonlae) and genetic alteration

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10
Q

What is the initial endothelial ‘injury’ or dysfucntion believed to trigger

A

Atherogenesis

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11
Q

Describe the formation of foam cells

A

Atherosclerosis follows the endothelial dysfunction, with increased permeability to and accumulation of oxidised lipoproteins, which are taken up by macrophages at focal sites within the endothelium to produce lipid-laden foam cells

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12
Q

What are fatty streals

A

Lipid-laden foam cell lesions which are seen as yellow dots or lines on the endothelium of the artery

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13
Q

What is a transitional plaque

A

The fatty streak progresses with the appearance of extracellular lipid within the endotheliu

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14
Q

What does release of cytokines such as platelet derived growth factor-β by monocytes, macrophages or the damaged endothelium promote

A

Further accumulation of macrophages as well as smooth muscle cell migration and proliferation

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15
Q

What separates the smooth muscle from the adaptive smooth muscle thickening in the endothelium

A

The proliferation of smooth muscle with the formation of a layer of cells covering the extracellular lipid

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16
Q

What is collagen produced in larger quantities by

A

Smooth muscle

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17
Q

What results in an advances or raised fibrolipid plaque

A

Accumulation of macrophages as well as smooth muscle cell migration and proliferation. Collagen is produced in larger and larger quantities

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18
Q

What does a 50% reduction in lumen diameter produce

A

A reduction in luminal cross-sectional area of approximately 70% causing a haemodynamically significant stenosis

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19
Q

What happens when a haemodynamically significant stenosis occurs

A

Smaller distal intramyocardial arteries and arterioles are maximally dilated (coronary flow is near zero) and any increases in myocardial oxygen demand provokes ischaemia

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20
Q

What is it called if the exposed material causes platelets to aggregate and completely occludes a vessel at the site of rupture

A

Thrombus

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21
Q

What is it called if the exposed material lodges further away

A

Thromboembolism

22
Q

What vessels are most likely to be atherosclerotic

A

Brain, heart, kidneys, eyes, abdominal aortic aneurysm

23
Q

What is a clincal risk factor

A

Any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury

24
Q

Give examples of types of risk factors

A

Acquired behaviour (smoking), Inherited (familial hyperlipidaemia), Complex disorder (hypertension/ Type 2 diabetes mellitus), Laboratory biomarker (hsCRP)

25
Q

What can risk factors predict

A

Disease onset

26
Q

Which factors are currently not modifiable

A

Genetic factors

27
Q

What are identified traditional risk factors for IHD

A

Age, sex, smoking history, hypertension, hyperlipidaemia, metabolic syndrome and T2DM

28
Q

Describe the nature of risk of IHD

A

It is accumulative and the more risk factors you have the greater you risk of IHD is

29
Q

What is the relative risk of IHD in smokers compared to non-smokers

A

3x greater

30
Q

What effect does stopping smoking have on life expectancy

A

Increases life expectancy at any age

31
Q

What are different types of treatments for nicotine dependence

A

Nicotine replacement therapy (patch or inhaler), bupropion, varenicline

32
Q

What effect does age have on systolic blood pressure

A

Increases with age

33
Q

What effect does age have on diastolic blood pressure

A

Declines

34
Q

What effect does age have on pulse pressure

A

Pulse pressure increases with age

35
Q

What is hypertension

A

140/90 or greater

36
Q

Who are people who have a high risk of high blood pressure

A

BP 130/80

37
Q

What is the relationship with blood pressure and prognosis

A

The higher the pressure the worse the prognosis

38
Q

What impact does every decrease in blood pressure by 1mmHg have on MI risk

A

Decreases MI risk by 2-3%

39
Q

When can’t you use ACE inhibitors or angiotensin

A

In the early weeks of pregnancy

40
Q

What effect does hyperglycaemia have on IHD

A

Increases IHD risk

41
Q

What does T2DM result in

A

Hyperglycaemia and insulin resistance

42
Q

What does each 1% reduction in HbA(1c) reduce

A

Risk of any end point related to diabetes, deaths related to diabetes, myocardial infarctions, microvascular complications

43
Q

What is metabolic sydrome

A

Central obesity (waist circumference 94cm for men and 80cm for women) plus two of the following four:
• Raised TG level: >150 mg/dL (1.7mmol/L)
• Raised HDL cholesterol:

44
Q

What is a non-traditional risk factor for IHD

A

Chronic inflammatory disease: rheumatoid arthritis, chronic obstructive pulmonary disease (COPD)

45
Q

Is it worthwhile treating IHD

A

It is possible that intervention is piggy backed on the natural history of the disease and that mortality is already in decline

46
Q

Across the developed world approximately how much of the decline in CVD deaths can be attributed to risk factor modification

A

50%

47
Q

Use of Aspirin

A

Reduction in serious cardiovascular events. Yet increased major GI and extracranial bleeds. Important to consider risks vs benefits

48
Q

What benefit does smoking cessation have on reduction in MI risk

A

50-70% lower risk

49
Q

What benefit does blood pressure reduction have on reduction in MI risk

A

2-3% risk reduction for every 2mmHg reduction in BP

50
Q

What benefit does HbA1c reduction have on reduction in MI risk

A

14% reduction in risk for every 1% decrease in HbA1c

Case 4 (7 decks)

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