Vascular Medicine Flashcards
Describe the formation of the fatty streak
Deposition of cholesterol underneath the endothelium
Uptake of lipid by macrophages - break down and remove lipid
If macrophages become overloaded with lipid - turn into foam cells - basis of fatty streak
BUT reversible lesion.
Describe how the fatty streak then goes on to become a plaque
Fatty streak = Inflammation
Recruit immune cells to site
If these cells become overwhelmed - leads to lipid peroxidation
This causes the breakdown of macropahes and release of free lipid into the cell wall.
Get lipid core with surrounding inflammation
if the overlying cap of this is thick and fibrous = STABLE plaque
If cap becomes thin, may rupture. Exposes underlying lipid core which prompts thrombosis. If this completely blocks artery can get MI/Stroke/Critical Limb
What are the 6Ps of critical limb ischaemia?
Pain Pallor Pulselessness Parathesia Paralysis Perishingly Cold
Describe how peripheral arterial disease is diagnosed
Using the ABPI - ankle brachial pressure index
Ratio of systolic BP at the ankle to the systolic BP in the brachial artery
0.9 - 1 = Normal
0.7 - 0.9 = Mild
0.4-0.7 = Moderate
List the modifiable and non-modifiable cardiovascular risk factors
NON-MODIFIABLE
Age, Male Gender, Family Hx, Ethnicity, Previous CVD
MOIFIABLE
Hypertension, Hyperlipidaemia, Smoking, Diabetes
When should blood samples for cardiac markers be collected?
On admission and 6-9 hours after the onset of symptoms
What is levels of troponin are required to make a diagnosis of acute MI?
> 99th centile (TnT >14) AND a RISE OR FALL of >20% on the second sample
What is the definition of an acute MI?
Rise in tropinin + at least one of the following
Symptoms of ischaemia
ECG changes indicative of new ischemia
Development of pathological Q waves on ECG
Imaging evidence of loss of viable myocardium
What does the GRACE score calculate?
6 month mortality from cardiovascular disease
What is junctional bradycardia?
When the rate of the heart is an escape rhythm from the AV node
Rate = 40-60 bpm
What medications should patients be on after discharge from ACS?
Dual antiplatelet therapy
Beta-Blocker
Ace Inhibitor
Statin
Describe the significance of random blood glucose measurements
> 11.1 = consistent with a diagnosis of diabetes
7.9-11.1 - reflects impaired glucose handling
When should the possibility of familial hypercholesterolaemia be considered?
Patient has a total cholesterol >7.5 AND a family history of premature cardiovascular disease
Should be investigated for
List some of the effects of NSAIDs on the cardiovascular system that were picked up in the case
In patients who have had a previous MI, NSAIDs increase the risk of death and/or recurrent MI
NSAIDs (especially in combination with aspirin and clopidogrel, increase the risk of developing gastric ulcers
Regular doses of NSAIDs may increase the antiplatelet effect of low dose aspirin
What are the 5 different types of MI
TYPE 1 - usual MI TYPE 2 - imbalance between mycardial O2 supply and demand - ischaemia without definite CAD TYPE 3 - Sudden Death TYPE 4 - PCI associated MI TYPE 5 - CABG associated MI
