Atherosclerosis is the slow buildup of fatty plaque inside artery walls, the root cause of most heart attacks, strokes and peripheral artery disease. A risk visit looks for silent risk factors in a patient without symptoms and lowers the chance of a first event with lifestyle changes and, when needed, medication.
Key symptoms
- Usually no symptoms; found on screening
- Chest pressure with exertion (angina) if coronary arteries are narrowed
- Calf pain when walking that eases with rest (claudication)
- Brief episodes of weakness or vision loss (TIA)
- Erectile dysfunction as an early sign
What you find on exam
- Blood pressure in both arms, BMI and waist circumference
- Listen for carotid, abdominal and femoral bruits
- Foot pulses; ankle-brachial index if claudication
- Signs of high cholesterol: xanthomas, xanthelasma, corneal arcus
Tests
- Lipid panel: LDL, HDL, triglycerides, total cholesterol
- HbA1c or fasting glucose; kidney function
- 10-year risk with the PREVENT or Pooled Cohort Equations
- Coronary artery calcium score when the decision is unclear
Treatment basics
- Heart-healthy eating, 150 minutes a week of moderate exercise, weight loss
- Stop smoking
- Statin by risk level, such as atorvastatin; add ezetimibe if LDL stays high
- Control blood pressure and diabetes to targets
- Share the decision with the patient and recheck lipids in 4 to 12 weeks
Red flags
- Chest pain at rest or with less and less effort
- Sudden weakness, facial droop or trouble speaking
- LDL of 190 mg/dL or higher (possible familial hypercholesterolemia)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.