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mica week 7 Flashcards

1
Q

What are modifiable risk factors for cardiovascular disease

A

age

male

ethnicity

familial hypercholesterlaemia

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2
Q

What aremodifieable risk factors

A

diet

smoking

exercise

diabetes

hypertension

obesity

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3
Q

What are causes for primary hypertension

What are causes for secondary hypertension

A

secondary

renal diabetic nephropathy, PKD, glomerulonephritis

vascular, renal artery stenosis, coarctation of aorta

endocrine: conns, phaechromocytoma and cushing

drugs: alcohol, ampethamies, coccain, ciclosporin, COCP, corticosteroids

other connective tissue disorders such as

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4
Q

What percentage of hypertension is secondary

A

10

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5
Q

What are the different stages of hypertension?

A

Stage 1: 135/85-149/94mmhg

Stage 2: over 150/95

Stage 3: over 180/120

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6
Q

How do you treat hypertension

A

under 55

1st ACE or ARB

2nd ACE or ARB + CCB or thiazide

3rd Thiaze+ CCB+ ARB or ACE

over 55

1stCCB

2nd CCB+ ACE or ARB or thiazide

3rd Thiaze+ CCB+ ARB or ACE

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7
Q

How do you treat someone with stage 2 hypertension

A

drug treatment

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8
Q

how do you treat someone with stage 1 hypertension

A

stage 1

if over 80 higher threshold (150/90)

look for end organ damage (proetinuria, fonduscopy)

higher Q risk than 10%- drugs

Q risk lower than 10% and under 60 - talk to patient conservative is ok

Age under 40 look for secondary

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9
Q

someone has diabetes and hypertension

how would you treat him

A

ramipril

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10
Q

what is the life style advice to give to a hypetensive patient

A

stop smoking

reduce sodium intake

reduce caffein rich products

reduce alcohol

encourage exercise and healthy diet

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11
Q

63 year old male has stage 2 hypertneisonand no other PMH. What is his clinic BP target?

A

in clinic - 140/90

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12
Q

What are the targets for BP?

A

BP

less than 80 years old

140/90 in clinic

135/85 at home

over 80

150/100 in clinic

145/95 at home

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13
Q

What is the target blood pressure in diabetics?

A

same as the others

140/90 in clinic

135/85 at home

BUT with CKD

clinic 130/80

at home 125/75 (or ambulatory)

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14
Q

What do you do on an annual review in GP

A

checking compliance

Checking BP

checking renal function

  • U &E,Cr,e GFR
  • urine dipstick for protein

Asses Q risk

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15
Q

What is accelerated Hypertension?

A

180/120

Have to have signs of hypertension such as retinal haemorrhage and or paillooedema and end organ damage

Aetiology- causes are secondary hypertension (pre- eclapmsia, scleroderma or drugs such as coccaine)

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16
Q

how do people with accelerated hypertension present

A

asymptomatic

headache

seizure vomitting

17
Q

How do you treat accelerated hypertension

A
  • IV antihypertensive (sodium nitropusside, labetalol, GTN) aim to reduce over 24-48hours
  • close monitoring- bloods ech and CT head
  • investigation of underlying causes
18
Q

How do you differentiate between stage 3 and malignant hypertension?

A

malignant - symptomatic and end organ damage

19
Q

What do you use for the target cardiovascular risk with lipid modifying treatment

A

Look at non HDL cholesterol

20
Q

what is the aetiology of hyperlipidaemia

A

genetic -

obesity

hypothyrodism

diabtes

nephrotic

renal

alcohol

21
Q

who do you treat for lipid modification

A

primary:

look at Qrisk - over 10% - give medication

consider for all patient with high rik groups: over 85,CKD, T1DM

secondary prevention

all patients with established CVD advised to start a high intensity statin regardless of Qrisk

22
Q

What is part of the Qrsik ?

A
  1. age
  2. sex
  3. CKD
  4. hypertension
  5. diabetes
  6. smoking
23
Q

What is the lifestyle advice for hyperlipaemia

A
  • increase fish, fruit and vegetable, fibre, unsalted nuts,seeds, legumes
  • reduced: sugar, saturates fats, salt
  • stop smoking
  • weight loss
  • regular exercise
  • encourage reduction of alcohol intake
24
Q

how do you treat hyperlipaediamia

A

Atorvastatin

or simvastatin or rosuvastatin

25
Q

How do statin work?

What are the side effects?

A

How do statin work? HMG coA reductase

What are the side effects? myopathy, GI disturbance, headache, sleep disturbance

26
Q

What are the interactions of statins?

A

metabolised by cytochrome P450 isoenzyme CYP24A

NEED to

  1. amioderone
  2. clarithromycin, erythromyacine
  3. cyclosporine
  4. ketoconazole
  5. grape fruit juice

ALL THESE DRUGS ARE METABOLISED by Cyt P450

27
Q

What do youmonitor with a statin

A

review anualy

measure LFTS
MEasure cholesterol

28
Q

What congenital conditions exist that could cause an unexoexpected death

A

long QT

HOCM

familial hypercholesterolaemia

29
Q

What is Familial hypercholesterolaemia

A

Autosomal dominant

cholesterol higher than 7.5

personal or familial history of premature CHD

Diagnosis

30
Q

What are signs of familial hypercholesterolaemia

A

xanthomata

xanthalasma

corneal arcus

31
Q

What are causes ofaortic stenosis

A

artherosclerosis - calcification (over50%)

HOCM

rheumatic fever

bicuspid valve (in younger patients)

other SLE, pagets

32
Q

What are key symtpoms

A

SAD

syncope

Angina

Dypnea

33
Q

ON examination what would you see in aortic stenosis

A

ejection systolic murmur

radiates to carotids

loudest in aortic area

narrow pulse pressure

34
Q

What are the investigations for aortic stenosis

A

ECHO

35
Q

What are the treatments for aortic stenosis

A

valve repair surgery

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