coronary heart disease

Question 1

Which bit of the vessel is atherosclerosis in?

Answer 1

Tunica intima

Question 2

What does Q risk measure

Answer 2

10 year risk CVD

Question 3

Above what Q risk should you intervene?

Answer 3

> 10%

Question 4

What bloods are taken to assess cardiovascular risk

Answer 4

Lipid profile- total cholesterol, HDL, non HDL, triglycerides

CK

LFT

Renal function, eGFR

HbA1c

Question 5

What interventions should you give if Q risk is >10?

Answer 5

1. lifestye advice and if this doesn’t work:
2. Statins- atorvostatin 20mg OD (if primary prevention) which can be increased

or 80mg OD (if secondary prevention- have diagnosed CVD)

Also consider the blood pressure- treat as with HTN if high

Question 6

SEs atorvostatin?

Answer 6

Myopathy and rhabdomyolysis

Question 7

Who should be offered cardiovascular risk assessment?

Answer 7

Cardiovascular risk assessments should be offered every 5 years to all patients over 40 years of age with no history of cardiovascular disease

and to all patients, regardless of age, with a first-degree relative who has premature atherosclerotic cardiovascular disease or familial dyslipidaemia.

Question 8

Who are ‘high risk’ for cardiovascular disease?

Answer 8

established cardiovascular disease

chronic kidney disease (eGFR <60 mL/minute/1.73 m2)

albuminuria

familial hypercholesterolaemia

over 40 years of age with diabetes mellitus (or under 40 with dm if T1>10yrs, T2>20yrs, end organ complications)

Question 9

Which statin has a higher risk of myopathy?

Answer 9

Simvastatin

Question 10

What additional preventative medication should be offered to patients with established atherosclerotic disease?

Answer 10

Aspirin 75mg OD

Question 11

What is f/u after starting a statin?

Answer 11

3 months later. Do total cholesterol, HDL and non-HDL

Aim for >40% reduction in non-HDL cholesterol

Also do LFTs at 3mths and 12mths

Question 12

How often should statins be reviewed?

Answer 12

annually

Question 13

What do you do if they have not reached the 40% reduction target of the statin?

Answer 13

Check adherence and optimise lifestyle

Maybe increase dose

Question 14

If they get muscle SEs of the statin what should you do?

Answer 14

Check CK

If the SEs are intolerable, or if CK >/=5x the upper limit then stop the statin

NB CK can also increase in exercise

Question 15

What is a cardioprotective diet?

Answer 15

Low fat and saturated fat

High fruit and veg

Oily fish

Unsalted nuts and seeds 4-5x/week

Whole grain carbs

Low salt and sugar

Question 16

Units in a pint

Answer 16

2-3

Question 17

Units in a small glass of wine

Answer 17

1.5

Question 18

Units in a large glass of wine

Answer 18

3.5

Question 19

A post MI cardiac rehab discussion should involve what

Answer 19

Lifestyle assessment

Educate on risk factors, angina vs MI, medication, diet, return to work, driving

Symptoms they get

Refer as appropriate e.g. to smoking cessation

Exercise- can get structured group exercise

Advice on stress management

Question 20

When can someone return to work, sex, exercise?

Answer 20

Whenever they feel ready

Question 21

Erectile dysfunction is common in CHD, how can you treat?

Answer 21

Phosphodiesterase-5 inhib (slidenafil) BUT don’t take within 24hrs of GTN and avoid in LT nitrate!

Question 22

What investigations should someone with angina get?

Answer 22

CT coronary angiography (Dye injected)

Invasive coronary angiography (catheter and xray)

Functional stress imaging test

Exercise ECG

Question 23

Angina treatment

Answer 23

1. GTN PRN
2. beta blocker/CCB OR IF THAT DOESN’T WORK: long acting nitrate e.g. isosorbide mononitrate.
3. Consider antiplatelet- aspirin 75mg OD
4. If also have CKD/HTN/HF/LV dysfunction/prev MI/diabetes- ACEi

Question 24

Can you drive after MI?

Answer 24

Yes, don’t need to inform DVLA