Ischaemic Heart Disease

Question 1

what score assesses CVD risk

Answer 1

ASSIGN score

age, sex, smoking, systolic BP, diabetes, deprivation, cholesterol, fhx

Question 2

what type of day to day interventions should doctors suggest for CVD

Answer 2

wt loss, smoking cessation, diet low in fats, limit alcohol intake, reduce salt intake

Question 3

what are signs of hyperlipidaemia

Answer 3

xanthomata, xanthelasma, tendon xanthoma

Question 4

tx for hyperlipidaemia

Answer 4

statins, PCSK inhibitors, ezetimibe, fibrates

Question 5

what is a genetic disorder resulting in excessively high cholesterol

Answer 5

familial hypercholesterolaemia

Question 6

what is the epidemiology of atherosclerosis

Answer 6

causes 1/3rd of all deaths, male

Question 7

what is the class progression of atherosclerosis

Answer 7

atheromatous plaque> fatty streak> fibrofatty plaque> complicated plaque

Question 8

what is atherosclerosis

Answer 8

formation of plaque in arteries

Question 9

how does a plaque form

Answer 9

1y endothelial injury e.g. smoking, accumulation of lipids, SM cells migrate to site

Question 10

causes of atherosclerosis

Answer 10

smoking, fatty diet, physical inactivity, alcohol, diabetes

Question 11

complications of atherosclerosis

Answer 11

arterial stenosis, arterial thrombosis, aneurysm, dissection, embolism

Question 12

what is an aneurysm

Answer 12

persistent dilation of an artery due to wall wakens - can rupture / erode adjacent structures

Question 13

what is a common aneurysm

Answer 13

AAA

abdominal aortic aneurysm- must be checked if acute umbilical pain presentation

Question 14

why is arterial stenosis bad

Answer 14

causes tissue ischaemia where myocytes are replaced by fibrotic tissue so loss of contractility> reduced elasticity & filling

Question 15

what is the prevalence of hypertension

Answer 15

25% of the population, higher in black

Question 16

what are the classes of hypertension according to cause

Answer 16

1y: no obvious cause-diet

or 2y: underlying disease e.g. renal

Question 17

what are the classes of hypertension according to consequence

Answer 17

benign: asymptomatic but may still cause disease
malignant: life threatening, diastolic BP >130

Question 18

what are rarer causes of hypertension

Answer 18

pheochromocytoma (tumour of adrenal gland) fibromuscular dysplasia (abnormal growth in wall of artery)

Question 19

what end-organ damage can hypertension cause

Answer 19

LV Hypertrophy, fibrinoid necrosis, microvascular injury (retinopathy etc), peripheral vascular disease, diabetes

Question 20

what happens in LV Hypertrophy

Answer 20

inc LV load > LV hypertrophy > muscle can’t all be perfused > myofibrils become unstable > ischaemia

Question 21

what are the ranges for hypertension

Answer 21

BP 140/90 (day time average: 135/85)= class 1
class 2: 160/100
class 3: systolic >180/ diastolic >110

Question 22

True/False…

RAAS pathway responsible for hypertension mechanism

Answer 22

True

Question 23

presenting symptoms of hypertension

Answer 23

asymptomatic, palpitations?

Question 24

Ix for hypertension

Answer 24

U&Es, glucose, cholesterol, ECG, BP

ambulatory BP monitoring

Question 25

Tx for hypertension

Answer 25

non-specific: wt loss, low salt, DASH, exercise

Rx: thiazide diuretics, ACEI, ARBs, b-blocker, Ca-channel inhibitors

Question 26

which Rx is given for resistant HT

Answer 26

spironolactone

Question 27

if younger than 55 what is the course of tx

Answer 27

ACEI > +Ca channel blockers> +thiazide diuretics

Question 28

if older than 55 what is course of tx

Answer 28

Ca channel blockers > +ACEI > +thiazide diuretics