Cardiovascular Disease

Question 1

What is ischaeimia?

Answer 1

Reduction of blood supply

Question 2

What is infarction?

Answer 2

Thrombus formation and occlusion of blood supply

Question 3

What are the stages of atherosclerosis?

Answer 3

Foam cell
Fatty streak
Intermediate lesions
Atheroma
Fibrous plaque
Complicated lesion/ rupture

Question 4

What are the big 5 risk factors for atherosclerosis?

Answer 4

Smoking
High cholesterol
High bp
Diabetes
Genetics

Question 5

With regards to smoking, what medication could be offered re. Smoking management?

Answer 5

Bupropion ( zyban)

Question 6

What predisposes a person to high cholesterol?

Answer 6

Poor lifestyle/ diet

Genetic contribution - family hypercholosterolaemia

Question 7

How is high cholesterol managed?

Answer 7

Drugs- statins

Dietary modification

Question 8

What is systolic bp at normal?

Answer 8

120

Question 9

What is diastolic bp at normal?

Answer 9

80

Question 10

When is it considered high bp?

Answer 10

160/90

Question 11

What can high bp be related to?

Answer 11

Obesity
Alcohol
High salt intake
Genetic

Question 12

What can be secondary’s causes of high bp?

Answer 12

Endocrine- hormone excess

Renal- poor kidney function

Question 13

Is high bp normally symptomatic?

Answer 13

Not unless very high

Question 14

What indicated very high bp?

Answer 14

250/130

Question 15

What signs might there be of very high bp?

Answer 15

Fits
Confusion
Headache
Breathlessness
Chest pain

Question 16

What is the management of high bp?

Answer 16

If untreated.. Postpone surgery requiring anaesthetic until controlled.

Question 17

What drugs are used in management of high bp?

Answer 17

Beta blockers- bisoprolol, atenalol
Diuretics- bendroflumethiazde
ACE inhibitors- ramapril
Angiotensin ll antagonists- valsartan
Calcium channel blockers- amlodopine

Question 18

How can you identify those at risk from family hx?

Answer 18

Score system

Question 19

What indicates…the healthy individual?

Answer 19

Non smoker
30 mins physical activity x5 weekly
Healthy diet
Not overweight 
Bp less than 140/90
Total cholesterol less than 5 mmol 
Normal glucose metabolism
Avoidance of stress

Question 20

What is peripheral vascular disease?

Answer 20

Atherosclerosis affecting peripheral vessels

• lower limbs
• abdominal aorta

Question 21

What are the chronic symptoms of peripheral vascular disease?

Answer 21

Intermittent Claudication- leg pain in calf when walking a distance

Question 22

What are the acute symptoms of peripheral vascular disease?

Answer 22

Ischaemic limb
Pain at rest
Pale, cold and numb limb
No sensation or movement

Question 23

What is the management of peripheral vascular disease?

Answer 23

Risk factor modification
Exercise program
Surgery
- bypass graft
-stent

Question 24

What is an abdominal aortic aneurysm?

Answer 24

Damage to vessel wall from atherosclerosis

- dilated aorta

Question 25

What are the risks of abdominal aortic aneurysm?

Answer 25

Rupture or tear

Question 26

What are the symptoms of abdominal aortic aneurysm?

Answer 26

``` Vague abdominal pain - acutely Severe ab pain Collapse High mortality ```

Question 27

Who is screening offered to re. Abdominal aortic aneurysms?

Answer 27

Males over 60

Question 28

Name clinical manifestations of ischaemic heart disease

Answer 28

Angina Acute coronary syndromes- heart attack/ unstable angina Heart failure Arrhythmias

Question 29

What is angina?

Answer 29

Visceral pain caused by lack of blood supply to the heart due to narrowing of arteries

Question 30

What are symptoms of angina?

Answer 30

Central chest pain, down left arm Atypically- jaw pain, upper abdomen, back Sometimes perceived as heaviness or breathlessness Often related to effort

Question 31

What are warning signs of unstable angina?

Answer 31

Angina at rest Unpredictable onset Increasing frequency Reduction of exertion

Question 32

What is unstable angina a warning sign for?

Answer 32

Heart attack

Question 33

What investigations can be done re. Ischaemic heart disease?

Answer 33

Electrocardiogram Exercise testing Coronary angiography

Question 34

What is a coronary angiography?

Answer 34

Access via femoral arteries Visualises blood vessels of the heart Can be combined with intervention- stents, balloon dilation

Question 35

How is stable angina managed?

Answer 35

``` Anti platelets- aspirin, clopidogrel Cholesterol- statins Symptom relief- beta blockers Calcium antagonists- amlodopine Nitrates- GTN, isosprbide mononitrate ``` Surgical- coronary angioplasty Coronary artery bypass grafting

Question 36

What can be described as a cute coronary syndromes?

Answer 36

Myocardial infarction | Unstable angina

Question 37

What are symptoms of mi?

Answer 37

``` Crushing central chest pain Sweating Nausea Light headed Feeling of impending doom Cardiac arrest ```

Question 38

How would you manage acute coronary syndrome?

Answer 38

Hospitalisation O2, morphine, nitrates Diagnose- ecg, angiography Clear clot- thrombolysis, angioplasty

Question 39

When would you not operate re. Symptoms of uncontrolled angina?

Answer 39

New onset Angina at rest Worsening

Question 40

Describe the basic pathology of atherosclerosis

Answer 40

Accumulation of lipid rich plaques in arterial walls