CVD Flashcards
What are the non-modifiable risk factors of CVD? List 7
pp 215
1. Age— increase with age
- Sex—♂ > ♀ in those < 65y
- Ethnic origin—in
the UK people who originate from the Indian subcontinent have increased risk, Afro- Caribbeans have decreased risk - Socioeconomic position*
- Personal history of CVD
- Family history of CVD—<55y ♂; <65y ♀
- Low birth weight (IUGR)
What are the MODIFIABLE (proven benefit) risk factors of CVD? List 10
- Smoking*—E p. 156
- Hyperlipidaemia—E p. 222
- Hypertension*—E p. 218
- DM*—E p. 326
- Diet*—E p. 148
- Obesity (particularly waist-hip ratio)*—E p. 152
- Physical inactivity*—E p. 154
- Alcohol consumption*—E p.158
- Left ventricular dysfunction/ heart failure (2° prevention)—E p. 234
- Coronary prone behaviour— competitiveness, aggression
and feeling under time pressure (2° prevention)—behaviour modification is associated with
d risk
What are the Modifiable (unproven benefit) risk factors of CVD? List 4
- Haemostatic factors—increased plasma fibrinogen
- Apolipoproteins—increased lipoprotein(a)*
- Homocysteine— increased blood homocysteine
- Vitamin levels—decreased blood folate, vitamins B12 and B6 Depression
Which 9 CVD risk factors account for 90% of risk for acute MI?
- Socioeconomic position*
- Hypertension*—E p. 218
- Physical inactivity*—E p. 154
- Alcohol consumption*—E p. 158
- Smoking*—E p. 156
- DM*—E p. 326
- Diet*—E p. 148
- Obesity (particularly waist-hip ratio)*—E p. 152
- Apolipoproteins—
increased lipoprotein(a)*
What is primary prevention in CVD? Aim?
Intervening before health effects occur
Aim is to Stop CVD from developing
What is the current risk estimation tool to calculate 10 years CVD risk?
QRisk3
What is secondary prevention in CVD?
Secondary prevention refers to preventing CHD and stroke through drug therapy and counseling for high risk individuals – such as those with previous events or known cardiovascular diseases (CVD).
Aims to stop progression of symptomatic CVD.
Who are the high-risk groups for developing CVD?
- All people aged >85y
- All patients with a familial dyslipidaemia—E p. 225
- People with eGFR <60 mL/min/1.73m2 and/or albuminuria
- People with type 1 DM who are >40y or have had DM for >10y or have
established nephropathy or other CVD risk factors - People with 10y CVD risk of ≥10% using the QRisk3 calculator
What are the causes of hypertension?
Causes of HTN:
* Unknown (‘essential’)—95%; alcohol (10%) or obesity may be contributory factors
- Endocrine disease—Cushing’s (both syndrome and 2° to steroids); Conn’s syndrome; phaeochromocytoma; acromegaly; hyperparathyroidism; DM
- Renal disease
- Pregnancy
- Coarctation of the aorta—E p. 252
__% of all adults have HTN
20%
More than __% of people aged >60y have hypertension
50%
How might someone with HTN present at the GP clinic?
- Usually asymptomatic and found during routine BP screening or incidentally. Occasionally headache or visual disturbance
- May be symptoms of end-organ damage—LVH, TIAs, previous CVA/ MI, angina, renal impairment, PVD
BP criteria for Stage 1 HTN?
Stage 1 hypertension:
Clinic BP ≥140/90mmHg and daytime
average ABPM/HBPM ≥135/85mmHg
BP criteria for Stage 2 HTN?
Stage 2 hypertension:
Clinic BP ≥160/100mmHg and
daytime average ABPM/HBPM ≥150/95mmHg
BP criteria for severe HTN?
Severe hypertension Clinic systolic BP ≥180mmHg or clinic diastolic BP
≥110mmHg
What would be the first-line antihypertensive treatment choice for a 45 years old Caucasian man?
Offer ACE inhibitor
Angiotensin receptor blockers (ARBs) if ACE not tolerated
for age <55y OR African/ Caribbean origin
Target BP for 80 yrs old with HTN
<150/90
Target BP for <80 yrs old without any other comorbidities
<140/90
Target BP for T2DM patient
<140/80
Target BP for T1DM patient
<135/85
Target BP for CKD patient
<130/80
For patient with Stage 1 HTN, offer drug tx if age ____ and ≥ 1 of ____
if age < 80 years
AND ≥1 of:
target organ damage
established CVD
renal disease
DM
10 y CVD risk ≥ 10%
offer HTN drug Tx to stage 2 patients?
Yes, for all of them
When to prescribe Statin for HTN patients?
p 219
- HTN complicated by CVD
- Primary prevention in patients >40 y with HTN and 10y CVD risk ≥ 10%
Tx regime for HTN
Severity of chronic heart failure is assessed with?
Severity- New york heart association (NYHA)
1. No limitation, ordinary exercise doesn’t cause SOB, palpitations, fatigue
2. Slight limitation: comfortable at rest but ordinary activity causes symptoms
3. Marked limitation: comfortable at rest but less than ordinary activity causes symptoms
4. Symptoms at rest and worse with any activity
Management of CHF
Review: every 6mo
• Clinical state: functional capacity, fluid status, cardiac
rhythm, cognitive and nutritional status
• Screen for depression
• Manage co-morbidities
• Medications
Bloods: U&E, creatitine, eGFR
Non- pharmacological Measures: educate, lifestyle, restrict fluid
intake, vaccinations- pneumococcal and influenza
Prognosis of CHF based on severity
Prognosis
• 50% die suddenly- due to arrhythmia
• Mild/ moderate: 20-30% 1year mortality
• Severe: >50% 1 year
AFib symptoms
Symptoms
• Asymptomatic
• Palpitations, chest pain, stroke/ TIA, SOB, light-headed,
syncope
AFib treatment
AFib treatment
