GP: Cardiovascular disease Flashcards
5As of motivational interviewing
Ask—identify patients with risk factors
Assess—assess level of risk factor and readiness to change
Advise—provide written information, a behaviour prescription, brief advice and motivational interviewing
Assist—offer drug therapy, if appropriate, and support for self-monitoring
Arrange—arrange referral to special services (eg dietitian, exercise physiologist), social support groups, phone information or counselling services, and follow-up review.
Groups automatically at high cvd risk (hint: ABCDE)
A, B, 3C, D, E ATSI >74 BP > 180/110 Cholesterol >7.5, CKD, familial hypercholesterolaemia Diabetes >60 or with microalbuminuria Established CVD
When should you do a CVD risk calculator and when should you review
Every second year from age 45
From age 35 in ATSI
Low: <10% review 2yearly
Mod: 10-15% review 6-12mo
High: >15% review to clinical context
Risk factors in Absolute CVD risk calculator (hint: there are 9)
Mnemonic: LSD in the BATH(S)
LV Hypertrophy
Smoking
Diabetes
BP Age Total cholesterol HDL cholesterol Sex
Stratified treatment of CVD
Low risk: treat if BP >160/100
Mod risk: 3-6mo lifestlye intervention, treat earlier if BP >160/100
High risk: immediately commence BP and lipid lowering drugs
Lipid and BP targets
Lipids (4,2,1 rule)
Total cholesterol: <4
LDL: <2, triglycerides <2
HDL >1
BP target <140/90
Adverse effects of statins
Muscle pain characterised by:
bilateral pain
aching or stiffness (rather than shooting pain or cramping)
pain located in the large muscle groups (eg thighs, buttocks)
onset 4 to 6 weeks after starting or increasing the dose of a statin
high-dose or high-potency statin therapy
elevated serum CK concentration that decreases with statin withdrawal.
- Elevated ALT
- Rhabdomyolosis (very rare)
- Necrotising autoimmune myopathy
Common causes of secondary HTN
Renal artery stenosis
Renal parenchymal disease
Adrenal and other endocrine disorders.
Drug-induced hypertension is also an important (and often overlooked) cause of secondary hypertension.
HTN emergency: definition, associated conditions, complications treatment
Definition: >220/140, urgency >180/110
Treatment: IV hyralazine (1st line) or metoprolol (2nd line) bolus therapy
Associated conditions
- Adrenergic crisis- phaeochromocytoma or stimulant abuse (treat with phentolamine- alpha blocker + benzos)
- Stroke- urgent BP reduction only in haemorrhagic strokes
- Pre-eclampsia/eclampsia: labedalol, hydralazine
- Baroreflex dysfunction and autonomic dysreflexia - - (Common causes include urinary retention, catheter blockage, constipation, urinary tract infection and pressure sore complication- treat cause of noxious stimuli)
Complications
- Acute pulmonary oedema (if this is present, treat BP with iv GTN)
- Aortic dissection (adequate analgesia + IV beta blocker, followed by IV sodium ntroprusside/gtn
- Hypertensive encephalopathy
- Papilloedema + cerebrovascular haemorrhage.
Lipid lowering agents
Primary prevention
1st line: atorvoastatin/rosuvastatin (10-80mg OD for Primary Prevention, 40-80mg OD for Secondary Prevention), Simvastatin (10-80mg OD for Primary Prevention, 20-40mg OD for Secondary prevention
2nd line:
- Ezetimibe 10mg OD - inhibits intestinal absorption og dietary and biliary cholesterol @ brush border)
- PCSK9 inhibitors (used in familial hypercholesterolaemia): monoclonal antibodies blocking breakdown of LDL receptors –> more available for uptake –> decreased circulating levels
- Bile acid resins –> interrupt reabsoprtion of bile acids- reducing intrahepatic cholesterol –> increasing LDL receptors –> decreased blood LDL
- Fibrates (for high tryglycerides)
- Nicotininc acid - used in bad LDL: HDL ratio, lowers lipoprotein A levels
First line BP lowering agents
ACEi
ARB
Ca channel blocker
Thiazide diuretics
