CVS Flashcards
How to estimate CVS risk
QRISK2 score (online)
At what QRISK score are statins started
10yr risk of 10%
Medical mx of smoking cessation
Nicotine replacement therapy NRT
Bupropion
Varenicline
E-cigarettes
Different forms of NRT
patch gum inhalors lozenges sprays
Bupropion mech of action
affects addictive behaviour in brain
antidepressant
Advise on Bupropion use
8 week course
stop smoking in 1-2 wks through the course
doubles the chance of quitting after 3 mo
CI to bupropion
epilepsy
bipolar
eating disorder
breast feeding
CI to NRT
None
Varenicline mech of action
partial agonist of nicotine receptor
reduces cravings and rewarding effect of smoking
Varenicline vs bupropion
v= more effective, but more SEs so prescribed less often
E-cigs mech of action
deliver vaporised nicotine
BP and age
BP increases with age
How many times to measure BP in clinic if high first time
If HTN at 1st, repeat, if significantly lower, repeat again
BP= lowest of the last 2 measurements
What to do if someone is hypertensive in clinic
Ambulatory BP monitoring (ABPM) 24HRS
or
Home BP monitoring (HBPM) over 7 days
Whats involved in HBPM
7 days, twice daily measurements
BP= average of all readings
Stages of HTN
Stage 1 : >140/90 or A/H BPM >135/85
Stage 2: >160/100 or A/H BPM > 150/95
Severe: clinic >180/110
Lifestyle advice for HTN
stop smoking
increase exercise
reduce salt intake
moderate alcohol consumption
When to medically rx HTN
If severe (even before A/H BPM) or stage 2 HTN Stage1 HTN with high QRISK (>20%)
HTN meds
CADB or ACDB (if <55)
1) If <55, ACEi or ARB. CCB if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + diuretic (Thiazides)
4) (resistant hypertension) Another diuretic (spironolactone) or β or α blockers
example of thiazides used for HTN
Indapamide
Which 2 drugs should be avoided together if poss in HTN?
B blockers and thiazides
impairs glucose tolerance and induces DM
When to consider specialist advice on chol/TG levels
Tot chol > 7.5 + FH premature CHD (<50yo) > 9 TG > 10 > 4.5 + tot chol>7.5
Starting dose of statins for primary prevention of CVD
atorvastatin 20 mg
SEs of statins
- GI upset (consider milder simvastatin)
- Myalgia, myopathy, rhabdomyolysis
- Liver function
- DM
Which bloods need to be tested for statins and when
at start, 3 and 12 mo
liver transaminases
if >3 times normal, stop
Diet advice for CVS risk
- reduce sat fats and cholesterol
- increase mono-unsat fat intake (eg olive oil)
- use wholegrain varieties of starch
- reduce sugar intake
- eat 5 fruit/veg a day
- eat 2 portions of fish, 1 oily fish /wk
- eat 4 portions of unsalted nuts, seeds /wk
- limit alcohol to 14 units/wk
Exercise advice for CVS risk
Per wk:
- 150min moderate aerobic or 75min high intensity
- 2 days of muscle strengthening (all muscles each time)
Secondary prevention post MI
- ACEi or ARB
- 75 mg Aspirin + 12mo of clopidogrel (or anticoagulation + aspirin for AF)
- BB 12mo (for life if L ventricular problem)
- 80 mg atorvastatin
Driving restriction post MI
4 wks or 6 (for bus/lorry drivers)
BP measurement different devices
Aneroid (tends to under-read)
Mercury (most accurate, but safety issues)
Electronic
How to select the correct cuff for bp
in adults:
- a cuff’s bladder length should be >2/3 of circumference of the arm
- a cuff’s bladder height should be >1/2 of circumference of the arm
How does too big of a cuff affect readings
gives BP lower than it is
How does too small of a cuff affect readings
gives BP higher than it is
Which arm normally gives a higher BP
right (always use right to record BP)
Normal variation in BP between 2 arms
10 mmHg
Pulsus paradoxus
BP goes down on inspiration
How much BP difference is normal between inspiration and expiration
5 mmHg
more than 10 pathological
Causes of pathological pulsus paradoxus
cardiac tamponade
constrictive pericarditis
severe asthma
emphysema
