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Medicine Podiatric > wk 1- CVD > Flashcards

wk 1- CVD Flashcards

1
Q

what age do people need to be screened for CVD risk and recommended times going forward

A

45+ every 5 years

35years for ASTI people

people regarded as high risk already are
-CVD patients
-DM if >60yrs
-CKD

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2
Q

modifiable and non modifiable risk factors of CVD

A

MOD:
hypertension
dyslipideamia
smoking
obesity
sedentary
alcohol
DM

NON MOD:
-family history
gender (male)
age

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3
Q

define dyslipidaemia

A

derangement of plasma lipid levels (cholesterol and or triglycerides)

associated with atherosclerosis, PAD, CAD, STROKE

hypercholesterolaemia
hypertriglyceriaemia
mixed dyslipidaemia
LOW HDL

primary: gene mutations which result in excessive production or decreased clearance of LDL/trigylcerides or decreased production, increased clearance of HDL

secondary: low levels of activity, excessive dietary intake of sat fats, cholesterol and trans fats

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4
Q

patho of ASCVD

A
  1. lipids (cholesterol and triglycerides) are insoluble in blood therefore theyre transported within lipoproteins
  2. Lipids (now monoglycerides, fatty acids and cholesterol) leave micelles and reassemble into chylomicrons which transport lipids around the body

3.liver synthesis lipoproteins to transport cholesterol and cholesterol

-LDL is either cleared by liver or taken up into vascular endotheliium
-HDL are initially cholesterol free and transport cholesterol from tissues to other cells or liver for clearance

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5
Q

dyslipidaemia/ ASCVD symptoms

A

usually asymptomatic

heart attack
stroke
or picked up on health screening

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6
Q

hypertrigylceride symptoms

A

acute pancreaitis with severe upper abdominal pain which may radiate to back
nausea
vomiting
pallor
diaphoresis

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7
Q

high levels of LDL symptoms

A

corneal arcus (deposits of lipids around corneal margin of eye

tendinous xanthomata

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8
Q

management of dyslipidaemia

A
  1. lifestyle changes
    activity 30mins - decreases TG and increases HDL
    diet- mediteranian and low in sat and trans fats
  2. medications when
    - patient has ASCVD or
    - high CVD risk or
    - 3-6months with lifestyle changes at mod risk and fam history of premature CVD

medication is typically lifelong so other causes need to be ruled out

for high LDL cholesterol
1. statin
2. ezetimbe
3. fibrate

for hypertrigylceridaemia
1. fibrate and omega 3 fatty acids

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9
Q

define hypertension

A

sustained elvation of BP

systolic BP >140mmHG
diastolic BP >90mmhg or both

primary: most common due to activation of sympathic nervous system, RAAS overactivity, vasodilator deficiency in endothelium

secondary: due to primary aldosteronism or chronic kidney disease or other diseases/conditions

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10
Q

hypertension symptoms

A

asymptomatic usually

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11
Q

diagnosisng hypertension and grades

A

calibrated sphygmomanometer

grade 1: 140/90
grade 2- 160/100
grade 3: 180/110

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12
Q

hypertension management

A
  1. lifestyle modifications
    cease smoking
    regular exercise
    reduce alcohol and salt
    better diet
    lose weight
  2. medications
    starts when
    - BP 160/100
    -mod-high CVD risk and 140/90 BP
  3. ACE/ARB/CCB/BB/thiazide diuretic
  4. after 3 months add a second
    3.” 3rd
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13
Q

define coronary artery disease

A

Impairment of blood flow through the coronary arteries, which supply
blood to the heart muscle (myocardium)

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14
Q

patho of ACS

A
  1. Athersclerosis caused by uptake of lipids in vasuclar endothelium of the coronary arteries leads to progressive narrowing
    and reduction in blood flow
  2. stabiliy of the plaque influences the presentation
    - stable angina
    -rupture and thrombosis results in ACS
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15
Q

signs of stable angina and ACS

A

stable: chest pain triggered by exertion and settles with rest
ACS: chest pain present at rest and increased in frequency/severity/duration

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16
Q

testing for CAD

A

ECG
cardiac markers

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17
Q

management of CAD

A
  1. medications
    -antiplatelets
    -statins
    -ACE/BB/CCB
    -nitrates for angina
  2. surgery
    - coronary artery bypass grafting
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18
Q

management of ACS

A
  1. hospital
    -oxygen
    -aspirin
    -nitrates
    -morphine
    -BB
    -anticoagulants
  2. STEMI OR NSTEMI
    -STEMI: urgent coronary angiography and artery bypass or thrombolysis
    -NSTEMI: prompt bypass

patients with stent need dual antiplatelet for 12 months following then aspirin alone lifelong

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19
Q

complications of myocardial infarction

A
  • Electrical (arrhythmia, conduction disturbances)
  • Mechanical (heart failure, myocardial rupture)
  • Thrombotic (recurrent coronary ischaemia, mural thrombosis)
  • Inflammatory (pericarditis, effusion, joint pain)
20
Q

What is heart failure

A

Syndrome of ventricular dysfunction

Typically secondary to CAD but can occur due to many heart conditions

21
Q

Diagnosis of HF

A

ECG
Chest x ray

22
Q

Management of HF

A
  1. Manage causes
  2. Fluid and salt restriction
  3. Activity
  4. Medications (ACE/ARB/BB/LOOP/DEFIBRILLATORS)

Median survival after diagnosis is 3-4years

23
Q

What is AF

A

Rapid and irregular arrhythmia of the hearts upper chambers

Typically secondary to heart conditions/diseases

24
Q

Symptoms of AF

A

Palpitations
Fatigue
Breathlessness

25
Q

Complications of AF

A

Formation of atrial thrombus which embolisms and causes stroke

26
Q

Management of AF

A
  1. Rhythm control (electrical or chemical)
  2. Rate control with anticoagulant
27
Q

Chest pain red flags

A
  1. Crushing/heavy/tearing chest pain -ACS
  2. Shortness of breath- reduced blood flow to lungs
  3. Loss of consciousness -reduced perfusion
  4. Racing heart rate or low BP - significant disease
28
Q

What is peripheral arterial aneurysms

A

Abnormal dilations of peripheral arteries caused by weakening of arterial wall (athleroscelrosis)

Usually involves popliteal artery

29
Q

Symptoms and diagnosis of popliteal arterial aneurysm

A

Asymptomatic

Imaging- often US, CT OR MRA

30
Q

Management of popliteal arterial aneurysm

A

Rupture is rare so unless symptomatic, repair isn’t necessary

31
Q

What is PAD

A

Atherosclerosis of an extremity resulting in ischaemia, more common in males

CAD is the cause of death in majority of patients with PAD

32
Q

Symptoms of PAD

A

Some asymptomatic

  • intermittent claudication: pain on exertion, relieved by rest
    -rest pain, particularly when legs are elevated
  • ulceration: painful punched out ulcers on bony promiences
33
Q

Diagnosis of PAD

A
  • ABI /TPI
  • Doppler
    -angiography
34
Q

Management of PAD

A
  1. Manage risk factors/conditions
  2. Exercise
  3. Preventative foot care
  4. Medication (anti platelet, ACE, statin, etc\
  5. Per cutaneous transluminal angioplasty (PTA): non surgical method for dilating occlusions
  6. Surgery: revascularisation with bypass or endarterectomy
35
Q

Peripheral venous disease (chronic venous insufficiency)

A

Impaired venous return due to hypertension which is caused by venous valve damage (DVT/trauma/age/genetic)

36
Q

Symptoms of PVD (CVI)

A

Heavy achy legs
Worse when standing
Worse when static
Swelling
Skin changes

37
Q

Diagnosis of PVD (cvi)

A

Venous doppler

38
Q

Management of PVD (CVI)

A
  1. Elevation, compression, wound care
  2. Surgery is inefficient as chronic venous insufficiency is recurrent
39
Q

PVD Varicose veins

A

Dilated superficial veins, resulting from venous vavlular insufficiency

More common in females bc oestrogen weakens valves, pregnancy increases venous pressures

40
Q

Management of Varicose veins

A
  1. Compression stockings
  2. Surgery
    But treatment has high risk of recurrence
41
Q

Deep vein thrombosis DVT

A

Clotting of blood in a deep vein which results in impaired venous return, endothelial dysfunction and hypercoagulability

Also known as the virchows triad

Embolism of DVT is the main cause of pulmonary embolism

42
Q

Risk factors for virachows triad

A
  1. Altered blood flow (surgery, immobility, dehydration, obesity)
  2. Endothelial injury (previous DVT, smoking, trauma)
  3. Hypercoagulability (malignancy, pregnancy, hypercoagulability disorders like factor V Leiden
43
Q

Complications of DVT

A
  1. Pulmonary embolism
  2. Post thrombotic syndrome
44
Q

DVT management

A
  1. Compression stockings
  2. Anticoagulants
45
Q

What is superficial thrombophlebitis

A

Blood clot in superficial veins

At risk of DVT

Medicine Podiatric (11 decks)

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