CVD

Question 1

What are CVDs

Answer 1

Dx of heart and blood vessels and covers heart and entire CVS

Question 2

CVDs comprise

Answer 2

CAD-MI and angina
HTN
Stroke
PVD(CV dx outside brain and heart)

Question 3

What percentage of annual death contributed by CVD

Answer 3

Estimated 32%

Question 4

The basis for most CVD are

Answer 4

Endothelial dysfunction
Atherosclerosis

Question 5

Majority of CVD is caused due to

Answer 5

Atherosclerosis

Question 6

Path of atherosclerosis

Answer 6

Fat streaks and inflammatory cells accumulate in vessel wall
Plaque become unstable over time and rupture
Thrombus forms which may occlude vessels

Question 7

Ethnic/Races can be at higher risk of developing CVD

Answer 7

Afro-Caribbean
Asian
Black Race

Question 8

Risk factors

Answer 8

Hypertension
Smoking
Dyslipidemia and Diabetes Mellitus
Inactive/Sedentary lifestyle
Overweight/Obese
Unhealthy eating
Excessive alcohol

Question 9

Novel Risk factors

Answer 9

Homocysteine
Fibrinogen
Impaired fibrinolysis
Increased platelet reactivity
Hypercoagulability
Lipoprotein
Inflammatory-infectious markers
CRP

Question 10

Definition of HTN

Answer 10

Office SBP >_ 140 and or DBP >_ 90 mmHg

Question 11

BP association with CV risk is extend from low BPs such as

Answer 11

SBP > 115 mmHg

Question 12

Hypertension complications

Answer 12

Stroke
MI
Heart Failure
Retinopathy
CKD

Question 13

Epid in Ghana has shown that the factors that lead to HtN

Answer 13

Positive perception of obessity
More sedentary lifestyle
Excessive consumption of high calorie diets
Genetic disposition
High intake of salts

Question 14

90-95% attibuted to Primary Hypertension

Answer 14

True

Question 15

Strong and independent risk factors assoc with HtN development

Answer 15

Central obessity
Age
Family Hx

Question 16

HTN normally clusters with CV risk factors like

Answer 16

Dyslipidemia
Glucose Intolerance

Question 17

Which system estimates the 10yr risk of first fatal atherosclerotic event

Answer 17

SCORE(systemic coronary risk evaluation)

Question 18

General principles in Hypertension diagnosis

Answer 18

Establish disease and grade
Screen for secondary causes
Identify contributing factors, concomitant risk factors and disease
Establish HMOD, early CVD or renal disease

Question 19

Very High risk pt using the SCORE have 10y score of greater than 10%

Answer 19

True

Question 20

10yr SCORE of >10% may have any of these

Answer 20

Clinical CVD
Unequivocal documented CVD on imaging
DM with End Organ Damage
Sever CKD(eGFR<30)

Question 21

High risk patients have a SCORE value of

Answer 21

5-10%

Question 22

High Risk SCORE pt may have

Answer 22

Hypertensive LVH
Moderate CKD(eGfR 30-59)
People with DM
Elevation of a single risk factor

Question 23

Moderate and Low Risk SCORE are what values

Answer 23

1-5%
<1%

Question 24

Management after established HtN include two well established strategies of BP lowering amongst the ff

Answer 24

Lifestyle interventions
Drug treatment
Device based therapy(not yet proven as effective)

Question 25

Reduction of SBP and DBP by 10 and 5 resp has what positive outcomes

Answer 25

Reduced major CV event by 20% Reduced all cause mortality by 10-15% Reduced stroke by 35% Coronary events by 20% Heart failure by 40%

Question 26

Five treatment classes proven to reduce BP

Answer 26

ACEIs ARBs Beta blockers CCBs Duiretics(Thiazides ans Thiazide-like)

Question 27

The treatment options were selected based on

Answer 27

Proven BP reduction Proven reduction of CV events in Placebo controlled studies Proven broad equivalence in CV mort/morbidity

Question 28

Benefits of ACEIs/ARBs

Answer 28

Reduce albuminuria Delay progression of CKD Prevent or regress HMOD(LVH,Small artery remodeling) Indicated post-MI/HFrEF Reduce LV associated AF Metabolic neutrality Anti-atherosclerotic

Question 29

Which treatment class has more stroke reducing benefits than Bp lowering

Answer 29

CCBs

Question 30

CCBs are more effective than ACEIs in HFrEF

Answer 30

False are less effective generally

Question 31

CCBs are more effective than ACEIs in HFrEF

Answer 31

False are less effective generally

Question 32

CCBs are more effective than BB in slowing HMOD like

Answer 32

Carotid atherosclerosis LVH and proteinuria

Question 33

Chlrothalidome and Indapamide are proven to be better than HCTz in

Answer 33

Potency in BP reduction Longer DOA Lower dose to reduced CV events and mortality

Question 34

Which beta blockers are vasodilatory

Answer 34

Labetalol Carvedilol Celiprolol Nebivolol

Question 35

Nebivolol has more favourable benefits on

Answer 35

Central BP Aortic atiffnes Endothelial dysfunction

Question 36

Classical BB have significant sexual dysfunction SEs except

Answer 36

Nebivolol

Question 37

There are level IA evidence on which lifestyle recommendations

Answer 37

Salt restriction to <5g per day Alcohol restriction less than 14:8 units/wk m:w Increased DASH(veggies, fish nuts not meat high fat etc) Body wt control Regular aerobic exercise

Question 38

Evidence class for smoking cessation contributions to Bp control is

Answer 38

IB

Question 39

Beta blockers are normally not first line in initial therapy of HtN but must be considered strongly for which specific conditions

Answer 39

HF Angina Post MI A-Fib Reproductive women

Question 40

In uncomplicated HtN initial therapy is with

Answer 40

ACEIs + CCB or diuretic(monotherapy is there’s low risk or pt >80yr)

Question 41

Initial therapy of HTN with CAD has what treatment option added

Answer 41

ACEIs/ARBs BB or CCB BB + Diuretic CCB+ Diuretic or BB

Question 42

HTN with CKD benefits from treatment with medications for uncomplicated HtN which includes

Answer 42

ACEIs/ARBs CCBs Diuretics(may use loop diuretics) Spirinolactone(25-50mg od)addendum in resistant HtN

Question 43

Which treatment option is not to be used in HTN with Hf

Answer 43

Non dipine CCBs

Question 44

What is the Bp goal for an over 60 yr old hypertensive

Answer 44

<150/90