CVS Disease

Question 1

What is atherosclerosis?

Answer 1

-A combination of atheromas (fatty deposits in artery walls) and sclerosis (process of hardening/stiffening of blood vessel wall)

Question 2

Pathogenesis of atherosclerosis?

Answer 2

Caused by chronic inflammation + activation of the immune system in artery wall –>causing deposition of lipids followed by the development of fibrous atheromatous plaques

Question 3

What do plaques cause?

Answer 3

1) Stiffening of artery wall –> hypertension + heart strain
2) Stenosis –> reduced blood flow
3) Rupture –> thrombus can block vessel causing ischaemia e.g. (ACS)

Question 4

Non-modifiable atherosclerosis risk factors?

Answer 4

1) older age
2) FHx
3) male

Question 5

Modifiable risk factors?

Answer 5

1) smoking
2) alcohol
3) poor diet - high sugar + trans-fat w/ reduced fruit, veg + omega 3
4) low exercise
5) obesity
6) poor sleep
7) stress

Question 6

Co-morbidities that increase risk of atherosclerosis?

Answer 6

1) diabetes
2) hypertension
3) CKD
4) Inflammatory conditions (RA)
5) atypical antipsychotics

Question 7

End results of atherosclerosis?

Answer 7

• angina / MI
• TIA / stroke
• peripheral vascular disease
• chronic mesenteric ischaemia

Question 8

Prevention of CVS disease?

Answer 8

Primary prevention - for patients that haven’t had CVS disease in the past

Secondary prevention - for patients who’ve developed angina, MI, TIA, stroke or peripheral vascular disease already

Question 9

How would you optimise modifiable risk factors?

Answer 9

1) advise on diet, exercise + weight loss
2) stop smoking
3) stop drinking alcohol
4) optimise co-morbidities e.g. diabetes

Question 10

What score would you use prior to starting primary prevention?

Answer 10

QRISK 3 - calculates % risk of having a stroke or MI in the next 10 years

Question 11

What is meant by a QRISK 3 of over 10%

Answer 11

more than 10% risk of stroke or MI over the next 10 years

Question 12

primary prevention for QRISJ 3 >10%?

Answer 12

Atorvastatin 20mg at night

Question 13

Which co-morbidities is a statin also offered too?

Answer 13

If CKD or T1 diabetes for more than 10 years

Question 14

Monitoring after starting a statin (NICE)?

Answer 14

Lipids

• -> check at 3 months
• -> increase dose to aim for 40% reduction in non-HDL cholesterol

LFTs

• -> check within 3 months + at 12 months
• -> don’t need to stop if AST/ALT rise is <3x upper limit of normal

Question 15

Secondary prevention of CVS disease?

Answer 15

4 A’s:

1) Aspirin (plus 2nd anti platelet such as clopidigrol for 12 months)
2) Atorvastatin 80mg
3) Atenolol (or other beta-blocker such as bisoprolol) titrated to max dose
4) ACE inhibitor (ramipril) titrated to max dose

Question 16

Notable side effects of statins?

Answer 16

1) myopathy - check CK if muscle pain/weakness
2) T2 diabetes
3) haemorrhage stroke (rarely)