Cardiovascular Disease Lecture

Introduction

• Presenter: Tom from Zero to Finals
• Topic: Cardiovascular Disease (CVD)
• Resources available at Zero to Finals website:
  • Written notes: zerodefineas.com/CVD
  • Cardiology section of Zero to Finals Medicine book

Atherosclerosis

• Definitions:
  • "Athero": Soft or porridge-like
  • "Sclerosis": Hardening or stiffening
• Pathology:
  • Combination of fatty deposit accumulation (atheromas) and hardening of the arterial wall (sclerosis)
  • Affects medium and large arteries
  • Caused by chronic inflammation and immune system activation in artery walls
• Consequences:
  • Stiffening of artery walls -> Hypertension due to increased resistance
  • Stenosis -> Reduced blood flow causing Angina or Peripheral Vascular Disease
  • Plaque rupture -> Thrombus formation leading to Ischemia and Acute Coronary Syndrome

Risk Factors for Atherosclerosis

• Non-Modifiable:
  • Older age
  • Family history
  • Male gender
• Modifiable:
  • Smoking
  • Alcohol consumption
  • Poor diet (high sugar, trans fats)
  • Inadequate fruits, vegetables, Omega-3s intake
  • Low exercise, Obesity
  • Poor sleep, Stress
• Medical Comorbidities:
  • Diabetes (Type 1 & 2)
  • Hypertension
  • Chronic Kidney Disease
  • Inflammatory conditions (e.g., Rheumatoid arthritis)
  • Use of atypical antipsychotics

Clinical Approach

• History Taking Tips:
  • Focus on exercise tolerance, diet, past medical and family history, occupation, smoking
  • Assess modifiable vs non-modifiable risk factors

Consequences of Atherosclerosis

• Established Cardiovascular Diseases:
  • Angina
  • Myocardial Infarction
  • Transient Ischemic Attacks (TIA)
  • Strokes
  • Peripheral Vascular Disease
  • Chronic Mesenteric Ischemia

Prevention of Cardiovascular Disease

• Primary Prevention:
  • Prevent CVD in patients with no history
  • Optimize modifiable risk factors
  • Conduct Q Risk 3 scores:

    • 10% risk over 10 years -> Start Atorvastatin 20mg

    • Chronic Kidney Disease or Type 1 Diabetes >10 years -> Automatic start of Atorvastatin
• Secondary Prevention:
  • Prevent recurrence in patients with CVD history
  • The "Four A's":
    • Aspirin
    • Atorvastatin: Increase to 80mg post-CVD
    • Beta Blocker: Atenolol or Bisoprolol
    • ACE Inhibitor: e.g., Ramipril

Statin Side Effects

• Myopathy:
  • Muscle pain/weakness
  • Check Creatine Kinase levels
• Type 2 Diabetes:
  • May cause or worsen glucose control
• Hemorrhagic Strokes:
  • Rare; benefits usually outweigh risks

Additional Resources and Support

• Zero to Finals website:
  • Notes, illustrations, test sections, and blog
  • YouTube channel support:
    • Thumbs up, comments, subscribe for updates