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My Cardiovascular > Risk factors > Flashcards

Risk factors Flashcards

1
Q

What is the most common cause of premature death?

A

CHD

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2
Q

What is atherosclerosis?

A

a progressive disease that involves a buildup of plaque in the arteries

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3
Q

What is the plaque in atherosclerosis formed of?

A

fatty substances, cholesterol etc

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4
Q

What can be the consequence of a plaque in the artery?

A
  • bleeding into the plaque

- formation of a clot on the surface of the plaque which blocks the artery or causes stroke

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5
Q

What is the process of the pathogenesis of atherosclerosis?

A

endothelial damage → protective response results in production of cellular adhesion molecules → monocytes and T lymphocytes attach to sticky surface of endothelial cells → migrate through arterial wall to subendothelial space → macrophages take up oxidised LDL → lipid-rich foam

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6
Q

What does end stage of atherosclerosis lead to?

A
  • MI
  • Stroke
  • Critical leg ischaemia
  • Cardiovascular death
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7
Q

What are the risk factors for CHD?

A
  • Inactivity
  • Age
  • Family history/ ethnicity
  • High blood pressure
  • Heart disease
  • Diabetes
  • Smoking
  • Obesity
  • Previous strokes or TIAs
  • Oral contraception
  • Drinking alcohol
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8
Q

What diseases are associated with LDL cholesterol?

A
  • atherosclerosis
  • modified by low HDL
  • smoking
  • hypertension
  • diabetes
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9
Q

What is HDL lowered by?

A

smoking, obesity and inactivity

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10
Q

What is the process of cholesterol metabolism?

A

large, not dense molecules get broken down until LDL is formed, LDL can be taken up by LDL receptor in liver which is good or can be modified into macrophages

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11
Q

What do statins reduce?

A

reduce end point in CHD so reduce total cholesterol and LDL cholesterol

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12
Q

What are the other actions of statins?

A
  • improve endothelial dysfunction
  • increase NO
  • have antioxidant properties
  • inhibit inflammatory response
  • stabilise atherosclerotic plaques
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13
Q

What do statins inhibit?

A

HMG-CoA reductase

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14
Q

What are the types of high cholesterol signs?

A

Xanthelasma, tendon xanthomas, tuberous xanthomas and eruptive xanthomas

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15
Q

What are the diseases attributed to hypertension?

A

cerebral haemorrhage, stroke, LVH, MI etc

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16
Q

What are the two types of hypertension?

A

essential hypertension with no underlying cause (90%) or secondary hypertension with no underlying cause

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17
Q

What are the lifestyle modifications for reaching high blood pressure?

A
  • loss of weight
  • limiting alcohol intake
  • increasing physical activity
  • reducing salt intake, stopping smoking
  • limiting intake of foods rich in fats and cholesterol
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18
Q

What is the treatment for under 55s for hypertension?

A

ACE inhibitors
then add calcium channel blocker or thiazide-type diuretic
then all three

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19
Q

What is the treatment for over 55s or black patients for hypertension?

A

calcium-channel blocker or thiazide-type diuretic
add ACE
all

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20
Q

When do you give beta blockers for hypertension?

A

fertile female

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21
Q

What can type 2 diabetes lead to?

A

atherosclerosis

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22
Q

What is primary prevention?

A

preventing the disease

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23
Q

What is secondary prevention?

A

puts an end to the disease before it fully develops

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24
Q

What are the causes of atheroma?

A
  • cigarette smoking
  • hypertension
  • hyperlipidaemia
  • diabetes
  • age
  • sex
  • genetics
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25
Q

What is the pathogenesis of atheroma?

A
  • Primary endothelial injury
  • Accumulation of lipids and macrophages (increased LDL/reduced HDL)
  • Migration of smooth muscle cells
  • Increase in size
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26
Q

What can atheromatous plaques become?

A

fatty streaks, fibrofatty plaque or a complicated plaques

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27
Q

What is progression of atheroma associated with?

A

further loss of luminal patency and arterial wall weakness

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28
Q

What is a particular problem with fibrofatty plaques?

A

turbulent blood flow so more likely to rupture

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29
Q

What features make atheromatous narrowing more likely to cause critical disease?

A
  • disease if this is the only artery supplying an organ
  • if the artery diameter is small
  • if overall blood flow is reduced
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30
Q

What are the complications fo atheroma?

A 
stenosis
thrombosis
aneurysm
dissection
embolism
31
Q

What are the features of arterial stenosis?

A
  • narrowing of the arterial lumen
  • reduced elasticity
  • reduced flow in systole
  • tissue ischaemia
32
Q

What are the clinical effects of cardiac ischaemia?

A
  • reduced exercise tolerance
  • angina
  • unstable angina
  • MI
  • cardiac failure
33
Q

What are the features of cardiac fibrosis?

A
  • loss of cardiac myocytes
  • replacement by fibrous tissue
  • loss of contractility
  • reduced elasticity and filling
34
Q

What are the clinical effects of arterial thrombosis?

A

infarction of the tissue it supplies eg MI

35
Q

What is an aneurysm?

A

an abnormal and persistent dilation of an artery due to a weakness in its wall

36
Q

What are the types of aneurysm and what is the most common site?

A
  • mycotic
  • atherosclerotic
  • dissecting
  • congenital
  • arteriovenous
  • traumatic
  • syphilitic
    most common site is abdominal aorta
37
Q

What are complications of aneurysms?

A

rupture, thrombosis, embolism, pressure erosion of adjacent structures or infection

38
Q

What is arterial dissection?

A

splitting within the media by flowing blood so there is a false lumen filled with blood within the media

39
Q

What are the complications of arterial dissection?

A

sudden collapse and high mortality

40
Q

What are other associations with aortic dissection?

A

atheroma, hypertension, trauma, coarctation, Marfan’s and pregnancy

41
Q

What is an embolism?

A

both superadded thrombus and plaque material may break off and embolise

42
Q

What are the usual targets of embolism?

A

cerebral infarct renal infarct and renal failure and lower limb infarction

43
Q

What percentage of people have hypertension?

A

25%

44
Q

What is hypertension a risk factor for?

A

cerebral haemorrhage
atheroma
renal failure
sudden cardiac death

45
Q

How is hypertension classified?

A

by cause so primary or secondary

or according to consequences so benign or malignant

46
Q

What is hypertension determined by?

A 
CO (HR, contractility and blood volume)
peripheral resistance (constrictors or dilators)
47
Q

What is primary hypertension?

A 
no obvious cause
genetic
salt intake
protein intake
RAAS
sympathetic activity
48
Q

What are the types of secondary hypertension?

A
  • Renal
  • Endocrine
  • Aortic, renal artery disease or drug therapy
49
Q

What can renal hypertension be due to?

A 
renal artery stenosis
acute or chronic glomerulonephritis
chronic pyelonephritic
cystic diseases
interstitial nephritis
50
Q

What can endocrine hypertension be due to?

A

adrenal gland hyperfunction
Conn’s syndrome
Cushing’s syndrome
Pheochromocytoma

51
Q

What does benign hypertension eventually cause?

A
  • Left ventricular failure: increased LV load, poor perfusion, interstitial fibrosis, microinfarcts and diastolic dysfunction
  • Congestive heart failure
  • Increases atheroma
  • Increases aneurysm rupture
  • Renal disease
52
Q

What are the features of malignant hypertension?

A

serious, life-threatening, can develop from either benign primary or secondary, needs urgent treatment

53
Q

What does malignant hypertension cause?

A

cerebral oedema, acute renal failure, acute heart failure, headache and cerebral haemorrhage

54
Q

How often does pregnancy associated hypertension occur?

A

10% of pregnancies

55
Q

What are the complications of pregnancy associated hypertension?

A

pre-eclampsia and eclampsia

56
Q

How do you measure ABPM?

A

at least two measurements per hour during the person’s usual waking hours

57
Q

How do you measure HBPM?

A

two consecutive seated measurements one minute apart, twice a day for 4-7 days and first day is discarded

58
Q

What is masked hypertension?

A

Masked hypertension is high ABPM but low clinical pressure

59
Q

What is classified as stage 1 hypertension?

A

clinic 140/90 or daytime 135/95

60
Q

What is classified as stage 2 hypertension?

A

clinic 160/100 or daytime 150/95

61
Q

What is classifies as stage 3 hypertension?

A

clinic 180/110

62
Q

What tests should be offered if a patient is found to have hypertension?

A
  • Urine test for protein
  • Blood test for glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
  • Examination of fundi for hypertensive retinopathy
  • 12-lead ECG
63
Q

What are some other risk factors for hypertension?

A

LVH, raised creatinine, albuminuria and retinopathy

64
Q

What is seen on an ECG for LVH?

A

very large QRS on right

65
Q

What are common causes of secondary hypertension?

A

renal disease, obstructive sleep apnoea, aldosteronism and renovascular disease

66
Q

What are the uncommon causes of secondary hypertension?

A

Cushing’s, Pheochromocytoma, Hyperparathyroidism, Aortic coarctation and intracranial tumour

67
Q

What is the blood pressure aim for hypertensive patients over and under 80?

A

Aim for 140/90 or lower in people aged under 80

Aim for 150/90 or lower in people aged over 80

68
Q

What lifestyle changes should be implemented to reduce blood pressure?

A

Diet, weight reduction, exercise, alcohol and smoking

69
Q

How many mmHg is BP reduced by with weight loss?

A

Roughly lose 1mmHg for every kg lost

70
Q

What is the treatment for under 55s for hypertension?

A

ACE/ARB
add CCB
add D

71
Q

What is the treatment for over 55s and black African/Caribbeans for hypertension?

A

CCB
add ACE/ARB
add D

72
Q

What are the possible causes of resistant hypertension?

A
  • Non-concordance
  • White coat effect
  • Pseudohypertension
  • Drugs
  • Lifestyle
  • Secondary hypertension
  • True resistance
73
Q

What is the treatment of resistant hypertension?

A

spironolactone

My Cardiovascular (13 decks)

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