CVD Flashcards
What are CVDs
Dx of heart and blood vessels and covers heart and entire CVS
CVDs comprise
CAD-MI and angina
HTN
Stroke
PVD(CV dx outside brain and heart)
What percentage of annual death contributed by CVD
Estimated 32%
The basis for most CVD are
Endothelial dysfunction
Atherosclerosis
Majority of CVD is caused due to
Atherosclerosis
Path of atherosclerosis
Fat streaks and inflammatory cells accumulate in vessel wall
Plaque become unstable over time and rupture
Thrombus forms which may occlude vessels
Ethnic/Races can be at higher risk of developing CVD
Afro-Caribbean
Asian
Black Race
Risk factors
Hypertension
Smoking
Dyslipidemia and Diabetes Mellitus
Inactive/Sedentary lifestyle
Overweight/Obese
Unhealthy eating
Excessive alcohol
Novel Risk factors
Homocysteine
Fibrinogen
Impaired fibrinolysis
Increased platelet reactivity
Hypercoagulability
Lipoprotein
Inflammatory-infectious markers
CRP
Definition of HTN
Office SBP >_ 140 and or DBP >_ 90 mmHg
BP association with CV risk is extend from low BPs such as
SBP > 115 mmHg
Hypertension complications
Stroke
MI
Heart Failure
Retinopathy
CKD
Epid in Ghana has shown that the factors that lead to HtN
Positive perception of obessity
More sedentary lifestyle
Excessive consumption of high calorie diets
Genetic disposition
High intake of salts
90-95% attibuted to Primary Hypertension
True
Strong and independent risk factors assoc with HtN development
Central obessity
Age
Family Hx
HTN normally clusters with CV risk factors like
Dyslipidemia
Glucose Intolerance
Which system estimates the 10yr risk of first fatal atherosclerotic event
SCORE(systemic coronary risk evaluation)
General principles in Hypertension diagnosis
Establish disease and grade
Screen for secondary causes
Identify contributing factors, concomitant risk factors and disease
Establish HMOD, early CVD or renal disease
Very High risk pt using the SCORE have 10y score of greater than 10%
True
10yr SCORE of >10% may have any of these
Clinical CVD
Unequivocal documented CVD on imaging
DM with End Organ Damage
Sever CKD(eGFR<30)
High risk patients have a SCORE value of
5-10%
High Risk SCORE pt may have
Hypertensive LVH
Moderate CKD(eGfR 30-59)
People with DM
Elevation of a single risk factor
Moderate and Low Risk SCORE are what values
1-5%
<1%
Management after established HtN include two well established strategies of BP lowering amongst the ff
Lifestyle interventions
Drug treatment
Device based therapy(not yet proven as effective)
Reduction of SBP and DBP by 10 and 5 resp has what positive outcomes
Reduced major CV event by 20%
Reduced all cause mortality by 10-15%
Reduced stroke by 35%
Coronary events by 20%
Heart failure by 40%
Five treatment classes proven to reduce BP
ACEIs
ARBs
Beta blockers
CCBs
Duiretics(Thiazides ans Thiazide-like)
The treatment options were selected based on
Proven BP reduction
Proven reduction of CV events in Placebo controlled studies
Proven broad equivalence in CV mort/morbidity
Benefits of ACEIs/ARBs
Reduce albuminuria
Delay progression of CKD
Prevent or regress HMOD(LVH,Small artery remodeling)
Indicated post-MI/HFrEF
Reduce LV associated AF
Metabolic neutrality
Anti-atherosclerotic
Which treatment class has more stroke reducing benefits than Bp lowering
CCBs
CCBs are more effective than ACEIs in HFrEF
False are less effective generally
CCBs are more effective than ACEIs in HFrEF
False are less effective generally
CCBs are more effective than BB in slowing HMOD like
Carotid atherosclerosis
LVH and proteinuria
Chlrothalidome and Indapamide are proven to be better than HCTz in
Potency in BP reduction
Longer DOA
Lower dose to reduced CV events and mortality
Which beta blockers are vasodilatory
Labetalol
Carvedilol
Celiprolol
Nebivolol
Nebivolol has more favourable benefits on
Central BP
Aortic atiffnes
Endothelial dysfunction
Classical BB have significant sexual dysfunction SEs except
Nebivolol
There are level IA evidence on which lifestyle recommendations
Salt restriction to <5g per day
Alcohol restriction less than 14:8 units/wk m:w
Increased DASH(veggies, fish nuts not meat high fat etc)
Body wt control
Regular aerobic exercise
Evidence class for smoking cessation contributions to Bp control is
IB
Beta blockers are normally not first line in initial therapy of HtN but must be considered strongly for which specific conditions
HF
Angina
Post MI
A-Fib
Reproductive women
In uncomplicated HtN initial therapy is with
ACEIs + CCB or diuretic(monotherapy is there’s low risk or pt >80yr)
Initial therapy of HTN with CAD has what treatment option added
ACEIs/ARBs
BB or CCB
BB + Diuretic
CCB+ Diuretic or BB
HTN with CKD benefits from treatment with medications for uncomplicated HtN which includes
ACEIs/ARBs
CCBs
Diuretics(may use loop diuretics)
Spirinolactone(25-50mg od)addendum in resistant HtN
Which treatment option is not to be used in HTN with Hf
Non dipine CCBs
What is the Bp goal for an over 60 yr old hypertensive
<150/90
