CV disease Flashcards
What is atherosclerosis?
Combination of atheromas (fatty deposits in the artery walls) and sclerosis
This is followed by the development of fibrous atheromatous plaques
What causes atherosclerosis?
chronic inflammation and activation of the immune system in the artery wall.
What do the plaques in the arteries cause?
Stiffening of the artery walls leading to hypertension and strain on the heart
Stenosis leading to reduced blood flow (angina)
Plaque rupture - thrombus causing ischaemia e.g. ACS
Risk factors for CVD
Non-modifiable:
- Older
- Family history
- Male
Non-modifiable
- Smoking
- Alcohol
- Low exercise
- Poor diet
- Obesity
Medical conditions:
- DM
- HTN
- CKD
- Inflammatory conditions, such as rheumatoid arthritis
- Atypical antipsychotic medications
End results of atherosclerosis
Angina
Myocardial Infarction
Transient Ischaemic Attacks
Stroke
Peripheral Vascular Disease
Mesenteric Ischaemia
Primary prevention of CV disease should be offered in…
Perform a QRisk score
- If above 10% then offer statin (20mg ON)
All patients with CKD should be offered atorvastatin 20mg
All patients with T1DM for more than 10y should be offered atorvastatin 20mg
Blood tests to check with starting statin therapy
LFTs when starting and at 3m and 12m
Statins can cause a transient and mild rise in ALT and AST in the first few weeks of use and they often don’t need stopping if the rise is less than 3 times the upper limit of normal.
Secondary prevention of CV disease
Aspirin
Asecond antiplatelet such as clopidogrel for 12 months)
Atorvastatin 80mg
Bisoprolol - titrated to maximum tolerated dose
ACE inhibitor - titrated to maximum tolerated dose
Side effects of statins
GI upset - diarrhoea or constipation - main side effect
Myopathy (check creatine kinase in patients with severe muscle pain or weakness)
- Myalgia is a common side effect but if severe pain then could be rhabdomyolysis
Hyperglycaemia /T2DM
Haemorrhagic strokes (very rarely)
