macrovascular complciations

Question 1

DIAGRAM progession of atherosclerosis to form atheroma

Answer 1

initial lesion due to macrophage accumulation and foam cell production- fatty streaks then form due to INTRACELLULAR LIPID accumulation- lipid then spills out to form a core of extracellular lipid (atheroma), which surrounded by fibrotic layer (through collagen and VCSM- thrombosis may then occur on lesion

Question 2

factors increasing risk of CVD

Answer 2

fasting glucose above 6mmol low HDL/LDL (different for women to men) hypertension waist circumference IR/inflammation (via adipocytokines) and urine microalbumin lead to increased risk as well

Question 3

how factors affect different stages of atherosclerosis

Answer 3

IR, lipids and BP can lead production of extracellular lipids IR alone then leads to progression of atheroma and thrombosis

Question 4

danger of hyperglycaemia and diabetes

Answer 4

associated with much lower life expectancy- the longer someone has diabetes, the more damage it causes ie someone diagnosed earlier will die earlier

Question 5

diabetes in men vs women

Answer 5

increased risk of death in men, BUT increased risk of CVD in women

Question 6

risk of macro vs microvascular complciations with increased blood sugar

Answer 6

the higher your blood sugar, there is MUCH greater increase in retinopathy, but a SMALLER risk for infarction

Question 7

difference between microvascular and macrovascular disease in terms of danger

Answer 7

micro causes morbidity ONLY, macro causes that AND mortality

Question 8

post-MI survival in diabetics vs non diabetics

Answer 8

post-MI survival much lower in diabetics

Question 9

effect of ethnicity on CVD

Answer 9

south asians tend to be at greatest risk

Question 10

key concept of macrovascular disease

Answer 10

SYSTEMIC ie affects mutiple arterial beds, so different organs- eg in CEREBROVASCULAR DISEASE, likely to be multiple small infarcts in brain. in PERIPHERAL VASCULAR DISEASE, blockage of arteries (atheroma) supplying legs can affect multiple beds, leading to foot disease for example. finally, atheroma in artery supplying kidney causes RENAL ARTERY STENOSIS, which can lead to hypertension and renal failure

Question 11

effect of glucose lowering on CVD

Answer 11

has minor effect, mortality is not lowered, thus lipids and BP more important

Question 12

risk factors for macrovascular disease and thus clinical important

Answer 12

non-modifiable are age, sex, birth weight (lower weights more at risk) and certain genes. modifiable are dyslipidaemia (LDL/HDL), BP, smoking and diabetes (ie sugar)- thus aggressive treatment of all these is important eg statins

Question 13

canakinumab

Answer 13

reduces inflammation without lowering lipid levels- lowers risk of CVD, but problem is it increases risk of infection

Question 14

predisposing risk factors to DIABETIC FOOT DISEASE

Answer 14

although peripheral vascular disease (blockage) important, neuropathy (sensory, motor AND autonomic) more important

Question 15

epi of diabetic foot disdease- prevalence, amputation and beds

Answer 15

5% of diabetics have it- increases risk of amputation by 60*- 10% of NHS beds taken by diabetes, half of which due to foot disease

Question 16

pathway to foot ulcerations (breakage of skin)

Answer 16

sensory neuropathy (using monofilament as test) motor neuropathy- cannot balance weight on foot, so lotsof pressure on certain part of foot (shape of foot also lost) limited joint mobility- sugar sticks to collagen, preventing walking autonomic neuropathy- integrity of skin lost due to glands being affected= dry and weak peripheral vascular disease adds to problems- trauma, increased risk of infection (microbes love sugar) and other diabetic complications like retinopathy can help lead to ulceration

Question 17

types of foot ulcerations DIAGRAM

Answer 17

neuropathic foot- numb, warm (getting blood) but dry, foot pulses present, and ulcers at points where high pressure is (often at big toe) ischaemic foot- cold, no pulse, ulcers at foot extremities (where no blood going) both- combining the two

Question 18

how to assess foot of diabetic patient

Answer 18

appearance- is it deformed/calluses how does foot feel- hot/cold and or dry look at presence/absence of foot pulses look at neuropathy through fine touch

Question 19

managing diabetic foot disease

Answer 19

control diaebetes inspect feet daily- measure feet when buying shoes, and buy shoes with laces don’t cut nails too short (may causes ulcer), caution with heat, and don’t walk barefoot

Question 20

managing foot ulceration

Answer 20

relieve pressure through bed rest antibiotics revascularisation (angioplasty) debridement (getting rid off dead tissue as potential for infection) or complete amputation

Question 21

charcot foot DIAGRAM

Answer 21

where foot deformed so that most of weight through middle of foot- this would cause pain, but diabetics are neuropathic, so can’t feel it, thus constant walking causes ulceration