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7. Vascular > Lecture 2: atherosclerosis > Flashcards

Lecture 2: atherosclerosis Flashcards

1
Q

What are the risk factors for CVD?

A
  1. Dyslipidaemia
  2. HTN
  3. Cigarette smoking
  4. Type 2 diabetes
  5. Obesity
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2
Q

What is the most important risk factor for developing CVD?

A

Hypertension

High blood pressure damages the endothelium of conduit arteries (aorta, coronary, carotid, renal) promoting the development of atherosclerosis.

Hypertension increases afterload (the force the left ventricle needs to generate to expel blood into the aorta), and this causes left ventricular hypertrophy and cardiac ischaemia.

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3
Q

How does cigarette smoking relate to increased CVD risk?

A
  • Endothelial dysfunction
  • Inflammation
  • ↑ plaque vulnerability
  • ↑ thrombosis and ↓ fibrinolysis
  • ↑ activation of the sympathetic nervous system
  • ↑ risk of insulin resistance and type 2 diabetes
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4
Q

How does diabetes relate to increased CVD risk?

A
  • ↑oxidative stress
  • ↑ endothelial cell adhesion molecule expression
  • inflammation
  • effects on macrophages which promote the expansion of the necrotic core of plaque.
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5
Q

How would you reduce CVD risk?

A

Exercise !!

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6
Q

What does a lipoprotein consist of?

A
  1. A phospholipid outer layer
  2. A core off triglycerides and cholesterol esthers
  3. Lipoproteins on the cell surface
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7
Q

Describe a chylomicron

A
  • Transporting exogenous triglycerides from intestines to liver
  • B-48
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8
Q

Describe VLDL

A
  • Synthesised in the liver
  • Transporting endogenous triglycerides
  • B-100
  • VLDL can turn into IDL by gaining more cholesterol and donating triglycerides to HDL
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9
Q

How does LDL arise?

A

VLDL is made by the liver (Apo B100), which donates TGs to form IDL

IDL gets converted into LDL by lipoprotein hepatic lipase, which can then cause oxidation

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10
Q

What is the pathology in familial hypercholesterolaemia?

A

LDL receptor pathway defect

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11
Q

What are the characteristics of familial hypercholesterolaemia?

A

Autosomal dominant

Often present with TC > 7.5 mmol per L and LDL-C over 4.7 mmol per L

CVD at 55

Tendon xanthomata and arcus

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12
Q

What are the characteristics of homozygous familial hypercholesterolaemia?

A
  • TC over 16 mmol per L

- Cardiovascular disease in 20s and death in untreated patients at 34

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13
Q

How does sitostanol work?

A

Prevents uptake of cholesterol and blocks cholesterol from going into the vessel

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14
Q

What is the first lipid-modifying drug you’d prescribe?

A

Atorvastin (after lifestyle modifications)

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15
Q

What is mean arterial pressure influenced by?

A
  1. Blood volume
  2. Cardiac output
  3. Resistance of the system to blood flow
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16
Q

What cardiac changes occur with age?

A

S-BP goes up

Pulse pressure increases

17
Q

What effect does arterial stiffness have on systolic and diastolic BP?

A

Systolic pressure increases with stiffness

Diastolic pressure falls with stiffness

! The main determinant of pulse pressure is arterial stiffness: Coronary arteries are mainly perfused during diastole, if diastolic pressure falls due to stiffness, there is less perfusion

18
Q

How does NICE define HTN?

A

140/90

Patients with HTN often present asymptomatically

19
Q

How does blood pressure relate to CVD?

A

No matter how low your blood pressure is, the risk of stroke or CHD will continuously go down

There is no lower threshold at which there is no more benefit

20
Q

What is stage 1 HTN?

A

Clinic BP: 140/90 - 159/99

ABPM: 135/85 - 149/94

21
Q

What is stage 2 HTN?

A

Clinic BP: 160/100 - 180/120

ABPM: 150/95

22
Q

What is stage 3 HTN?

A

Clinic BP > 180 systolic or 120 diastolic

23
Q

What are the Korotkoff sound?

A
  1. Is a loud tapping sound → mark of systolic BP
  2. A soft swishing murmur-like sound → Can feature as ausculatory gap
  3. Crisp thumping → similar to sound 1
  4. Muffling
  5. Silence
24
Q

What is QRISK3?

A

The QRISK3 algorithm calculates a person’s risk of developing a heart attack or stroke over the next 10 years.

25
Q

What is the purpose of QRISK3?

A
  • 10 year risk >20%, treatment will benefit
  • Accept a 10% risk, anything over 10% you treat

Remember 2ndary prevention = Atorvastatin 80mg

7. Vascular (15 decks)

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