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Terms in this set (57)
Risk factors for CAD
HTN, DM, dyslipidemia, Fx of premature vascular disease
What is Metabolic Syndrome?
complex of clinical and metabolic features that increased likelihood for CAD events
Criteria to diagnose Metabolic Syndrome
weight circumference, high TG, Low HDL, high fasting glucose, HTN
(need 3 to make dx)
*LDL is not a criteria
Which HTN medications should be used for high risk patients (DM, LVH, proteinurea & atherosclerotic disease)?
ACEi and ARB's
Black pts should be given diuretics as first line therapy
What is the leading cause of death?
coronary artery disease
T or F. Everyone should be screened for heart disease with stress testing
F. only for sx pts and very high risk asx (DM, HTN)
What do ST depressions mean during a stress test?
If your pt has an abnormal baseline EKG (ST depressions @ rest or BBB) how should a stress test be conducted?
need to have image modality with EKG tredmill (nuclear or echo)
if your pt has an abnormal baseline EKG (ST depressions @ rest or BBB) and they cannot walk on the tredmill what should be done?
pharamcologic stress test WITH echo or nuclear (cannot just do pharmacologic stress test with EKG)
what is the TIMI risk score?
used as a prognostic indicator for unstable angina and non-ST elevation MI
what is included in the TIMI risk score?
age ≥ 65, ≥ 3 Risk Factors For CAD, documented prior coronary stenosis ≥ 50%, ASA use in past 24 hrs, ≥ 2 episodes of angina in the last 24 hrs, ST changes > 0.5mm, inc. Cardiac Markers
high risk ACS would be treated how?
early invasive approach (cath lab), pt gets plavix
low risk ACS would be treated how?
selectively invasive, no rush to cath lab
What medications do you give for ACS?
everyone gets ASA, BB, and probably L.M.W.H
what medication is given for ongoing discomfort?
what are two contraindications for beta blockers?
low blood pressure and heart block
T or F. The TIMI score tells you how to tx the patient with an MI
F. the TIMI score is just for prognostic purposes not for tx...there going to the cath lab ASAP anyway
finish this sentence "time is ____"
muscle (not money) dorr to balloon in <90 minutes
when do you use thrombolytics?
when the nearest cath lab is an hour away
When do you stent someone?
>70% stenosis and sx
T or F. Stents prolong the life of pts with >70% stenosis
False. Stents only reduce sx, they do not prolong life, therefore dont stent unless sx
what are the risks of PCI (percutaneous coronary intervention?
major bleeding 20% risk, disslodging plaque from the artery, perforating the atery
what medications do you give the pt after placing a stent?
ASA, Statin, Plavix, BB, ACE
which medications improve survival?
ACE and BB
what are the three different types of cardiomyopathy?
dilates, hypertrophic, restrictive
which cardiomyopathy(s) have a diastolic dysfuntion?
restrictive and hypertrophic
what is systole?
when the ventricles contract
what is diastole
when the ventricles relax
what is the best way to dx a cardiomyopathy?
echo, especially if EKG abn and murmurs heart
ventricular enlargement with severe systolic dysfunction, "big boddy heart", heart does not squeeze, dilated LV with minimal hypertrophy
a stiff otherwise normal looking heart
18 y.o suddenly collapses on the basketball court and dies, which cardiomyopathy does he probably have?
hypertrophic cardiomyopathy, therefore if picked up earlier (systolic murmur increasing with valsalva) this pt should not have been playing sports
Pt presents with hypotension, tachycardia, tachypnea, JVD and on echo an enlarged LV with minimal hypertrophy is seen
Pt presents with a systolic murmur that worsens with valsalva, and lessens with squatting. There is no HTN. This pt also has a diastolic dysfuntion filling of the heart.
T or F You should do a cardiac bx in order to diagnose CMP
F. the only reason to do a cardiac bx is to look for a graph rejection in a post transplant pt, you should do an echo
what is the goal with a pt that has a hypertrophic cardiomyopathy?
to keep the BP low, well hydrated and to reduce the overall contractible force of the heart and increase volume
Other than CHF, who is most at risk for sudden death and should therefore get a defibrillator?
hypertrophic and dilated CMP
if a pt has a dilated cardiomyopathy and the EF is _____ they should get a defibrillator
transient apical and midventricular LV dysfunction in the absense of significant CAD that is triggered by emotional or physical stress, "ballooning" of the apex during systole can be seen
Takotsubo cardiomyopathy "broken heart"
T or F. Once a pt is in stage B of CHF as defined by the ACC, they cannot go back to stage A
A pt with CHF c/o SOB while at rest, which class is he in?
A pt is asx but has LV Dysfunction, which stage of HF is he in?
B (stage A and B are both asx, while C and D show sx)
A pt has multiple risk factors for heart failure, but has no heart disease or sx, which stage is he in?
T or F. Once a patient is in class 2 they cannot go back to class 1.
False, in the NYHA class system, the class is soly dependent upon the sx, if the sx improve so can the class
What is a contraindicaton for dig?
what are two contraindications for ACEi?
renal failure and hyperkalemia
What is the goal of acute HF?
diuretics, diuretics, diuretics!
if diuretics dont work in acute HF what do you use?
inatropes (ex: dopamine)-for acute and decompensated HF but increases mortality
what is the best prognostic indicator for CHF?
what medications actually slow the progression of CHF?
ACEi and BB (increase lipe span)
when are spirinolactones used?
hypokalemia, class 3 and 4
what are some clinical characteristics of class C HF?
dyspnea, fatigue, reduced exercise tolerance
what medications are used for class C pt?
ACEi, BB, diuretics and possibly digitalis
what treatment is given for class D HF?
palliative therapy, mechanical assist devices and heart transplant
what tx is given for class B HF?
ACEi and BB in select pts
what tx is given for class A HF?
treat risk factors (HTN, DM, hyperlipidemia), avoid toxics and ACEi in selected pts
likelihood of sudden cardiac arrest with CHF?
when the EF is < 30% therefore get a defibrillator