Term
|
Definition
Distal Nail Separation from the Nail Bed.
A symptom of Hyperthyroidism |
|
|
Term
| Which Arrhythmia is associated with COPD? |
|
Definition
| Multifocal Atrial Tachycardia |
|
|
Term
| What is the usual Junctional Escape Rate? |
|
Definition
|
|
Term
| What is the Usual Ventricular Escape Rate? |
|
Definition
|
|
Term
| What are EKG signs of LVH? (5) |
|
Definition
R-wave > 20 in I, II, or III
R-wave > 11 in RVL
R-wave V5 + S-wave V2 > 35 |
|
|
Term
| What are the EKG signs of RVH? |
|
Definition
|
|
Term
| What are the EKG signs of Enlarged Atria? (2) |
|
Definition
p wave > 1X1 box V1 or
p wave > 2.5X2.5 lead II |
|
|
Term
| What is the definition of wide QRS? |
|
Definition
| > 3 boxes wide (0.12 sec) |
|
|
Term
| Evidence of WPW on EKG? (3) |
|
Definition
Short PR interval (< 3 boxes, 0.12 sec)
Tachycardia
Delta Wave (Slurred upstroke QRS) |
|
|
Term
| EKG diagnosis of Multifocal Atria Tachycardia? |
|
Definition
3 different p wave morphologies in the same lead
Tachycardia |
|
|
Term
| Treatment of A-fib with abherency |
|
Definition
| First line treatment, protect the ventricle with Procainamide. |
|
|
Term
|
Definition
Procainamide
Amiodarone
Cardioversion (If unstable)
Avoid Drugs that slow conduction through the AV Node, because they will encourage conduction through the accessory node (adenosine, beta-blockers, calcium channel blockers) |
|
|
Term
|
Definition
purine nucleoside
Part of ATP and cAMP
Blocks AV node causing temporary heart block |
|
|
Term
| What is a significant q-wave? |
|
Definition
|
|
Term
| Treatment of Narrow Complex SVT 2 Non pharm, 3 pharm) |
|
Definition
Carotid Massage (Check for Bruits first)
Valsalva
Adenosine 6 mg rapid IV Push
Diltiazem IV Titrate to Pulse
Beta Blockers IV Titrate to Pulse |
|
|
Term
| Treatment Stable Regular Wide-complex Tachycardia |
|
Definition
Treat like V-tach first (V-tach is more lethal than SVT)
Amiodarone 150 over 10 minutes
Elective Cardioversion
If no response and it might be SVT with aberrancy, try Adenosine (6mg IV Push)
However, if in doubt, protect against V-tach |
|
|
Term
Stable Irregular Wide Complex Tachycardia.
3 potential dx |
|
Definition
A. Fib with aberrancy- diltazem, beta blockers
A. Fibe with WPW (Call Cards) Amiodarone
Polymorphic V. tach (Call Cards) Very dangerous Amiodarone. |
|
|
Term
|
Definition
HTN
CAD
CHF
Obesity (Left Atrial Size increases with increased BMI)
Sleep Apnea
Left Atria > 4 cm
Congenital Heart Disease (Esp. ASD) |
|
|
Term
| A-fib Reversible causes(6) |
|
Definition
Alcohol
Hyperthyroidism
Pericarditis, Myocarditis
Surgery on Heart
MI
PE or other Pulmonary Disease |
|
|
Term
| Afib Evaluation (5 labs, 2 procedures) |
|
Definition
EKG
Echo
CBC
CMP (Comp Metabolic Panel)
TSH
Consider BNP/pro-BNP
Consider EtOH/Drug Screen |
|
|
Term
| A-fib effect on Ejection Fraction |
|
Definition
| 10% of Ejection Fraction may come from Atrial Kick |
|
|
Term
AFFIRM Trial (Atrial Fibrillation Follow-up Investigation of Rhythm Management)
What is more important: Rate or Rhythm control |
|
Definition
| Both Rate and Rhythm Control resulted in Ischemic Stroke Rate 1% per year |
|
|
Term
| What is the most common pharmacologic cause of stroke in A-fib |
|
Definition
| Warfarin discontinued or becoming sub-therapeutic |
|
|
Term
| Afib: Best Anticoagulant Treatment |
|
Definition
| Warfarin better than ASA and Plavix combined |
|
|
Term
| What is Dabigatran (Pradaxa) |
|
Definition
New Anticoagulant
Anticoagulant effect less variable than Warfarin
Monitoring not required
150mg bid CrCl>30; 75mg bid CrCl<30
No antidote |
|
|
Term
| Dabigatran vs Warfarin in Afib |
|
Definition
Stroke per year W 1.69%; D 1.11%
Major Bleed W 3.36%; D3.11%
Hem Stroke W 0.38%; D 0.1%
Mortality W 4.13% D 3.64% |
|
|
Term
|
Definition
Non-valvular A-fib INR 2-3
Valvular A-fib INR 2.5-3.5 |
|
|
Term
| Afib Acuity and Anticoagulation |
|
Definition
Onset<48 hours Cardioversion med or elect)
Duration >48 hours Anticoagulate for 3 weeks, Cardiovert, Anticoagulate for 4 weeks.
Need to Cardiovert Urgently, or onset unknown transesoph echo looking for clot in left atria |
|
|
Term
| Change in risk of stroke for Non-Valvular Afib with and without Warfarin |
|
Definition
Without warfarin 5%/year
With warfarin 2-3%/year |
|
|
Term
|
Definition
CHF 1 pt
HTN 1 pt
Age>75 1 pt
Diabetes 1 pt
Prior Stroke/TIA 2 pts |
|
|
Term
| How do you use CHAD Score? |
|
Definition
Assess Stroke Risk in Afib patients:
0 pts Low Risk ASA only
1 pt moderate risk ASA or Warfarin
>= 2 pt high risk Warfarin |
|
|
Term
| Clinical Indications SBE prophylaxis (6) |
|
Definition
Prosthetic Valves
Hx Infective Endocarditis
Unrepaired Cyanotic Congenital Heart Disease
Repaired Congenital Heart Disease in first month after Repair
Repaired Congenital Heart Disease with Residual Defects
Valvulopathy in a transplanted heart |
|
|
Term
| SBE No longer indicated for... (3) |
|
Definition
MVP with or without murmur
Bicuspid Aortic Valve
GI/GU procedures including any scope in any orifice doing any biopsy |
|
|
Term
| SBE indicated for which procedures (5) |
|
Definition
Dental Procedures on gingiva, periapical region, or perforate oral mucosa
Resp Tract Procedures that break Mucosa
Procedures in patients with ongoing GI/GU infections
Procedures on infected skin or MSK structures
Surgery to Replace heart valves, intravascular or intracardiac procedures |
|
|
Term
Which Drugs are used for SBE?
Primary (1)
Secondary (4)
IV (4) |
|
Definition
Amox 2 gm 30-60 min prior to procedure
PCN Allergy:
Cephalexin 2gm
Azithromycin 500mg
Clarithromycin 500mg
Clindamycin 600mg
IV:
Amp 2gm Can give IM
Cefazolin 1gm
Ceftriaxone 1gm
Clindamycin 600mg |
|
|
Term
| Which 2 valves are most commonly effected by Cardiac Valve Disease |
|
Definition
|
|
Term
| Which murmurs require evaluation (Based on Timing and Intensity) |
|
Definition
Any murmur in Diastole
Any murmur grade III or greater |
|
|
Term
| Which Two Valve Conditions Vary with Squat and How? |
|
Definition
MVP: When Pt Squats Click and murmur move later in systole
Hypertrophic Cardiomyopathy: When patient squats, murmur gets softer due to increased blood in LV |
|
|
Term
| Heart Murmur best heard over Right Precordial Area extending into neck? |
|
Definition
|
|
Term
| What percentage of pt > 75 have Aortic Stenosis? |
|
Definition
|
|
Term
| Percent of patients born with Bicuspid Aortic Valve? |
|
Definition
|
|
Term
|
Definition
1/3 Stenotic
1/3 Regurgitant
1/3 Minor |
|
|
Term
Tricuspid Vs Bicuspid for AS for those:
>70
Between 50 and 70 |
|
Definition
>70:
40% Bicuspid
50-70:
66% Bicuspid |
|
|
Term
| 4 Risk Factors for Aortic Stenosis |
|
Definition
Age: 10 year increase doubles Risk
Smoker: 35%
HTN 25%
Male: 2:1 versus Female |
|
|
Term
Aortic Stenosis Clinical Findings
Murmur (1)
Carotid (1)
PMI (2) |
|
Definition
Grade II-III mid systolic murmur radiating to carotids
Pulsus parvus et tardus (Slow Upstroke Carotid Pulse
PMI Prolonged (LVH)
PMI Laterally Displaced (Dilated LV) |
|
|
Term
| Aortic Stenosis Diagnostic Testing (3) |
|
Definition
EKG (LVH and Left Atrial Enlargement)
CXR
Cardiomegaly
Pulmonary Congestion
Aortic Calcifications
Echocardiogram |
|
|
Term
Classic Danger Symptoms of Aortic Stenosis (3)
What effect does this have on prognosis? (2-5 yr death rate without valve replacement) |
|
Definition
Angina, Syncope, heart failure
50% die within 2 to 5 years unless Aortic Valve is replaced. |
|
|
Term
| Aortic Valve Stenosis Treatment and Results (3) |
|
Definition
Replacement
Mechanical: Needs Anticoagulation
Biosynthetic: Only lasts 10-15 years
Balloon Valvuloplasty: Palliative only
Trans Aortic Valve Replacement: Consider in patients too sick for Valve Replacement, not willing to do only paliative measure |
|
|
Term
| Aortic Regurge History (3) |
|
Definition
Dyspnea on Exertion
Orthopnea
Fatigue |
|
|
Term
| Aortic Regurge disease Risk Factors (7) |
|
Definition
Hypertension
Primary Aortic Disease
Calcific Aortic Sclerosis
Bicuspid Valve
Marfan's
Syphilitic Aortitis
Collagen Vascular Disease |
|
|
Term
Aortic Regurge Diagnostic Signs
Heart sounds (1)
Pulse (2)
BP (1) |
|
Definition
Blowing Murmur Left Sternal Border
Corrigan Pulse (Water Hammer)
Quincke's Pulse (pressure on nail bed shows pulsation)
Wide Pulse Pressure |
|
|
Term
| Aortic Regurge Dx Tests (3) |
|
Definition
EKG (LVH)
Chest X-ray (Enlarged Heart and Aorta)
Echo |
|
|
Term
| Aortic Regurge Treatment (2) |
|
Definition
Afterload Reduction
CCB (Nifedipine)
ACE Inhibitors
Hydralazine (Side Effects Headache, Drug Induced Lupus)
Valve Replacement if highly symptomatic |
|
|
Term
| What are the 6 causes of Mitral Valve Regurge |
|
Definition
MVP (Most Common Cause)
MI (Papillary Muscle Dysfunction)
Annular Calcification
Endocarditis
Collagen Vascular Disease
Rheumatic Heart Disease |
|
|
Term
|
Definition
| Blowing Mid-Late Systolic Best Heard at Apex. Radiates to Left Axilla |
|
|
Term
| Mitral Regurge Diagnostic Testing (3) |
|
Definition
EKG (LVH or LAE)
Chest X-ray Cardiomegaly
Echo shows LAE and LVH (Left Atrium > 4 cm) |
|
|
Term
| Mitral Regurge Treatment (2) |
|
Definition
In symptomatic disease treat with ACEI to reduce LV volume and improve symptoms
Mitral Valve Repair |
|
|
Term
|
Definition
| 5% of population Male = Female |
|
|
Term
|
Definition
Palpitations
Syncope
Chest Pain
(Often Asymptomatic) |
|
|
Term
| MVP Physical Findings (2) |
|
Definition
Mid Systolic Click
Late Systolic Murmur |
|
|
Term
|
Definition
No Endocarditis Prophylaxis
Beta Blockers for Symptomatic Palpitations |
|
|
Term
| Mitral Stenosis Demographics (3) |
|
Definition
Female to Male 3:1
Develops in 40's and 50's
Caused by Rheumatic Heart Disease |
|
|
Term
| Mitral Stenosis Symptoms (4) |
|
Definition
Dyspnea on Exertion
Orthopnea
Paroxysmal Nocturnal Dyspnea
Hemoptysis (High Left Atrial Pressures Rupture Small Bronchial Veins) |
|
|
Term
|
Definition
Best Heard with Bell on Exhalation
Located at Apex with pt in Left Lateral Position
Low in Pitch
Can be accentuated with mild exercise |
|
|
Term
|
Definition
EKG LAE or later RVH
CXR LAE (Straighten Left Heart Border)
Increased Vascularity
Kerley B lines (Chronic Pulmonary Venous Engorgement) |
|
|
Term
| Mitral Stenosis Treatment 2 medical and 3 surgical |
|
Definition
Mild Symptoms Treat with Diuretics
Increased Risk of Afib. Tx with anticoagulation
Valve Replacement
Percutaneous Balloon Valvotomy
Open Commissurotomy |
|
|
Term
| Where are Tricuspid Murmurs best heard? |
|
Definition
| Lower Left Sternal Border |
|
|
Term
| Where are Pulmonic Murmurs best heard |
|
Definition
| Upper Left Sternal Border |
|
|
Term
| Pulmonary Hypertension PE (2) |
|
Definition
Fixed Split S2 Upper Left Sternal Border
Left Parasternal Heave from Right Ventricular Hypertension |
|
|
Term
| Pulmonary Hypertension Testing (2) |
|
Definition
EKG: RVH, RAE
Echo: Increase Pulmonary Artery Pressures |
|
|
Term
Myocardial Infarction Incidence (3)
Fraction of all deaths
Number of people in US with MI
What percent of MI deaths in the first hour |
|
Definition
1/3 of all deaths by 2020
1.2 million in US with MI
1/2 of all MI deaths occur in first hour. |
|
|
Term
| What is the most common event leading to MI |
|
Definition
| Plaque Rupture (Plaque Rupture is more likely in plaque with more lipids) |
|
|
Term
Difference in Mortality between STEMI and NONSTEMI MI
Early
After 1 year |
|
Definition
| STEMI has higher death rate early on, but the two have equal death rate at 1 year. |
|
|
Term
| Differential Diagnosis Chest Pain (5) |
|
Definition
GI disorders (Reflux)
Costochondritis
Panic Attacks
Pleurisy (and PE)
Acute Aortic Dissection |
|
|
Term
| Associated Symptoms MI (8) |
|
Definition
Nausea
Vomiting
Diaphoresis
Weakness
Dyspnea
Restlessness
Apprehension
Presyncope |
|
|
Term
MI Timing:
Length of Time for Pain
Relief by Nitroglycerin
Diurnal Patern |
|
Definition
20 minutes to a few hours (longer than anginal pain)
Not relieved by Nitroglycerin
Early Morning Hours |
|
|
Term
EKG Anatomy
Lateral
Anterior
Septal/Posterior
Inferior |
|
Definition
Lateral :I, aVL, V5, V6
Anterior: V1-V4
Septal/Posterior: V1, V2
Inferior: II, III, aVf |
|
|
Term
MI EKG Changes
Early Acute Change (2) |
|
Definition
| Early Acute: T waves increase in amplitude and widen in area of injury (hyperacute pattern) and ST segment depression in leads opposite of injury (reciprocal Changes) |
|
|
Term
| MI EKG Changes Evolved Acute Phase (3) |
|
Definition
ST segment elevation is resolving
T waves in injured area are inverted
Q waves fully developed (>0.03 sec and/or >30% R wave) |
|
|
Term
MI EKG Changes: Chronic Phase (1)
How long does it take for ST segment elevation to resolve |
|
Definition
| Resolution of ST Elevation can take up to 2 weeks. |
|
|
Term
Cardiac Markers: Troponin I
Time To Apperance
Duration
Sens at 6 hours
Sens at 12 hours
Specificity |
|
Definition
Onset:2-6 hours
Duration:5-10 days
Spec 6hrs:75%
Spec 12hrs:90-100%
Sensitivity: 98%
Test of Choice |
|
|
Term
Cardiac Markers: Troponin T
Time To Apperance
Duration
Sens at 6 hours
Sens at 12 hours
Specificity |
|
Definition
Onset:2-6 hours
Duration:5-14 days
Spec 6hrs:80%
Spec 12hrs:95-100%
Sensitivity: 95%
Test of Choice
Elevated In Renal Insufficiency |
|
|
Term
Cardiac Markers: CPK MB
Time To Apperance
Duration
Sens at 6 hours
Sens at 12 hours
Specificity |
|
Definition
Onset:3-6 hours
Duration:2-4 days
Spec 6hrs:65%
Spec 12hrs:95%
Sensitivity: 95%
Test of Choice for Recurrent Angina
Coorelates to Infarct Size |
|
|
Term
|
Definition
CBC
Basic Chemistry
Lipid Panel
PT/PTT |
|
|
Term
|
Definition
CXR
Echo
Radio Nuclide Scan |
|
|
Term
|
Definition
Age > 75 3
65-74 2
DM/HTN/Angina 1
SBP<100 3
HR>100 2
Killip II-IV 2
Weight<67kg 1
Ant STE or LBBB 1
Time to Tx> 4hr 1 |
|
|
Term
| TIMI for STEMI 30 day mortality |
|
Definition
|
|
Term
|
Definition
>65 1
>2 CAD Risk Factors 1
Stenosis > 50% 1
ASA use past 7 days 1
Severe Angina last 24hrs 1
increased Cardiace Markers 1
ST deviation > 0.5 mm 1 |
|
|
Term
| TIMI for NSTEMI 14 day risk of cardiac events |
|
Definition
Score Death/MI Death/MI/UrgRevasc
0-1 3 5
2 3 8
3 5 13
4 7 20
5 12 26
6/7 19 41 |
|
|
Term
| ST Segment Elevation Tx (2) |
|
Definition
PCI Door to CATH < 90 min
Fibrinolysis if Cath not available |
|
|
Term
|
Definition
MONA
Morphine
Oxygen
Nitroglycerin
ASA
+ Beta Blockers, Heparin |
|
|
Term
|
Definition
ASA
Clopidogrel
Beta Blockers
ACE/ARB
Lipid Lowering Agent
Nitroglycerin SL |
|
|
Term
|
Definition
Start 162-325
Maintain 75-162 |
|
|
Term
|
Definition
Initial 300 Maintenance 75
After PCI 3 months to 1 year
After NSTEMI as well (with ASA) |
|
|
Term
|
Definition
Metoprolol 25-200
Carvedilol 6.25-25 |
|
|
Term
|
Definition
Ramipril 2.5-10
Lisinopril: 5-10
Valsartan 80-160
Losartan: 50-100 |
|
|
Term
|
Definition
Atorvastatin 10-80
Simvastatin 20-40
Goal LDL < 100 Consider < 70
Consider Niacin/Fibrate for Low HDL |
|
|
Term
|
Definition
0.4 SL prn
Contra-indicated for Aortic Stenosis and Viagra |
|
|
Term
| Heart Disease Rank for Death and Morbidity |
|
Definition
Death Number 1
Morbidity Number 2 |
|
|
Term
Fraction of Americans that:
Smoke
Are Obese
Routinely Exercise |
|
Definition
Smoke 1/5
Obese 1/3
Exercise 1/3 |
|
|
Term
CAD
Lifetime Risk for:
40 yo Women
40 you Man |
|
Definition
Women: 33%
Man: 50%
White Males highest incidence
1.5% of primary care visits (18th most common dx) |
|
|
Term
| Pathophysiology of Artherosclerosis (2) |
|
Definition
1) Chronic Inflammation and deposition of calcium and lipid deposits within lumen of coronary artery
2) Calcium deposition in arterial muscle layer causes stiffening |
|
|
Term
| Traditional Risk Factors for CAD (4) |
|
Definition
Tobacco
Dyslipidemia
Hypertension
Diabetes |
|
|
Term
| Modifiable Risk Factors for CAD (3) |
|
Definition
Obesity
Physical Inactivity
Metabolic Syndrome |
|
|
Term
| Elements of Metabolic Syndrome (4) |
|
Definition
Atherogenic dyslipidemia (High Trigly, Low HDL)
Insulin Resistance
Elevated BP
Obesity (Specifically Waist Circumference) |
|
|
Term
|
Definition
Age
Family History
First Degree Relative
Early MI
Men < 55
Women < 65 |
|
|
Term
| CAD Equivalent Conditions (4) |
|
Definition
DM
Atherosclerosis of noncoronary arteries
Chronic Kidney Disease
Framingham Risk Score > 20% |
|
|
Term
| Definition of Atherosclerosis of non coronary arteries for the purpose of "equivalent" CAD condition (4) |
|
Definition
Low Ankle Brachial Index
Carotid Bruits Or Increase Intimal Thickening on Dopple Image
TIA or Ischemic Stroke
Aortic Aneurysm |
|
|
Term
| Framingham Risk Variables (7) |
|
Definition
Age
Gender
Total Cholesterol
HDL
Smoking Status
Systolic Blood Pressure
Dx of HTN |
|
|
Term
| Biomarkers that are risk factors for CAD (10) |
|
Definition
hs CRP
Cystatin C
Homocysteine
Folate
NT-BNP
Polyprotein B
Lipoprotein (a)
Immunologic and Thrombophilic markers
Insulin Resistance
LDL particle concentration |
|
|
Term
| Minor Disease Risk Factors for CAD (10) |
|
Definition
Anemia
Subclinical hypothyroidism
Migraine
RA
SLE
Venous Thromboembolism
Psoriasis
Childhood Cancer
Erectile Dysfunction
Retinopathy |
|
|
Term
| Psychosocial Risk Factors for CAD (6) |
|
Definition
Depression
Psychosocial stressors
Low socioeconomic status
Anger and hostility
Social isolation
Lack of quality social support |
|
|
Term
| Women's Risk Factors for CAD (5) |
|
Definition
Early menopause
HRT (Particular Est and Progest)
OCP + heavy smoking
Radiation therapy for Breast Cancer
Hx of Pre-ecalmpsia |
|
|
Term
| Other Misc Risk Factors for CAD (8) |
|
Definition
Abnormal EKG
Periodontal disease
C. pneumoniae DNA detection with antibodies
Heavy alcohol use
Heavy fat intake
High carbohydrate diet
Sleep disorders
Low Birth weight |
|
|
Term
| Factor that are not risk factors of CAD (7) |
|
Definition
OCP in non-smokers
Infection - HIV
Dairy consumption
Egg consumption < 2 per day
Coffee consumption
Serum K levels
Leptin levels |
|
|
Term
| 3 things that should guide treatment decisions around preventing CAD |
|
Definition
Traditional Risk Factors
CAD Equivalent Conditions
Framingham Score |
|
|
Term
| ACC/AHA Secondary Prevention (CAD or CAD Equivalent (7) |
|
Definition
-Early Symptom Response Education
-Dyslipidemia Treatment
-Weight and Physical activity intervention
-Smoking cessation
-HTN Tx
-Renin/Angiotensin/Aldosterone axis suppression
-Antiplatlet and/or Anticoagulant Tx |
|
|
Term
| Early Symptom Response Education (2) |
|
Definition
-Pt and Family education on risk and signs of STEMI
-Use NTG X 1. If no response in 5 minutes, call 911 |
|
|
Term
| Secondary Prevention Lipids (5) |
|
Definition
LDL < 100 (<70)
Trig < 150 (Statin + Niacin/Fibric Acid)
HDL > 40 (Niacin)
Dietary Restriction
Sat Fats < 7%
Chol < 200 mg/dy
Minimize Trans Fats
Dietary Supplements
Fiber 10 g/dy
Omega-3 Fatty Acids 1g/dy
Higher doses for Hypertrigly |
|
|
Term
| CAD Secondary Prevention Weight |
|
Definition
BMI 18.5 to 24.9
Male Waist < 40 inches
Female Waist < 35 inches
10% weight loss has proven benefit |
|
|
Term
| CAD Secondary Prevention: Exercise |
|
Definition
Min 30 min/dy 5 days per week
Medically supervised for high risk pts
Exercise Testing may be necessary to guide goals of testing |
|
|
Term
| Secondary Prevention: Smoking (4) |
|
Definition
Smoke Status on Every Pt
Continuous Encouragement to Quit
Avoid all Smoke Exposure
Liberal USe of Cessation Programs/Meds |
|
|
Term
| CAD Secondary Prevention HTN (3) |
|
Definition
Follow JNC VII
Goal 120/80
Do not use short acting dihydropyridine Calcium Channel Blockers |
|
|
Term
| When to use ACE in CAD (4) |
|
Definition
1) HTN
2) Systolic Heart Failure
3) Diabetes
4) CKD |
|
|
Term
| Beta Blockers in Secondary Prevention CAD (3) |
|
Definition
1) MI
2) Acute Coronary Syndrome
3) Systolic Dysfunction |
|
|
Term
| Consider Aldosterone Antagonists (Spironolactone) (4) |
|
Definition
Control HTN when already on ACE + Beta Blocker
HF
Diabetes
No CKD |
|
|
Term
CAD Secondary Prevention Antiplatlet Tx
Meds |
|
Definition
Daily Asa 75 - 162
Clopidogrel for Allergy
Warfarin for Allergy and Pt < 75
Asa + Clopidogrel for PCI for 1 year
Longer for patients with Drug Eluting Stent. |
|
|
Term
| Three Compelling Reasons to add Warfarin to your CAD anticoagulation therapy |
|
Definition
1) Atrial Fib/Flutter
2) Mural Thrombus
3) VTE |
|
|
Term
| 3 Goals of therapy for Angina |
|
Definition
1) Control Symptoms
2) Prevent Death
3) Prevent Progression of CAD |
|
|
Term
| Asymptomatic to Mildly Symptomatic patients: Medical Care vs Surgery |
|
Definition
No difference
Base Decision to revascularize on Symptoms, Severity of Ischemia on Imaging, prognosis |
|
|
Term
| Chronic Angina Beta Blockers and Ca Channel Blockers |
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Definition
All patients should be on Beta Blockers
Use Long Acting Calcium Channel Blockers (Norvasc [Amlodipine], Verapamil)
Norvasc has lower risk of decreased HR |
|
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Term
|
Definition
| 3rd line (after beta blockers and Ca Channel Blockers) |
|
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Term
| Ranolazine(Ranexa) in CAD |
|
Definition
Very Expensive
Slightly reduces Angina
Additive effect with Beta Blocker and CCB |
|
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Term
| 4 Meds that help with Angina Symptoms (Not Progmosis) |
|
Definition
1) Lipitor
2) Magnesium Supplementation
3) Chinese Herbal (suxiao jiuxin wan, Shenshao tablets)
4) Coenzyme Q10 |
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|
Term
| How many Americans have HTN |
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Definition
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Term
| HTN More common in high income or low income? |
|
Definition
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|
Term
| What percent of Americans with HTN are unaware they have the disease? |
|
Definition
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|
Term
| What ratio of adult deaths are linked to HTN? |
|
Definition
|
|
Term
How does the treatment of HTN reduce the following cardiac endpoints:
Stroke, MI, Heart Failure? |
|
Definition
Stroke 35 to 40 %
MI 20 to 25%
Heart Failure 50% |
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Term
|
Definition
Normal SBP<120 AND DBP <80
Pre HTN SBP 120-139 OR DBP 80-89
Stage 1 SBP 140-159; OR DBP 90-99
Stage 2 SBP >=160; OR DBP >=100 |
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Term
|
Definition
1) Consider BP 125/75 to 135/85
2) Patients with end organ damage need treatment regardless of end organ damage
3) Average >130/80 = HTN |
|
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Term
| Importance of SBP vs DBP over 50 |
|
Definition
| SBP is a more important risk factor for CAD than DBP after 50. |
|
|
Term
| What happens to CV risk as BP increases by 20/10? |
|
Definition
|
|
Term
| Persons with normal BP at age 55 have what percent lifetime incidence of HTN? |
|
Definition
|
|
Term
| Can Lifestyle Modifications help prevent HTN in pre hypertensive patients? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How many drugs do most HTN patients need to control their BP? |
|
Definition
|
|
Term
|
Definition
BP < 140/90
BP < 130/80 for patients diabetes or chronic kidney disease |
|
|
Term
| How does Isolated SBP differ in treatment guidelines? |
|
Definition
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|
Term
| 9 causes of secondary htn |
|
Definition
1) Sleep Apnea
2) Drugs and Alcohol (Particularly Cocaine)
3) CKD
4) Primary Aldosteronism
5) Chronic Steroid use or Cushings Syndrome
6) Pheochromocytoma
7) Coarctation of the Aorta
8) Thyroid or Parathyroid diaese
9) Renovascular Disease |
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|
Term
| 5 Target Organs with 3 kinds of damage to the Heart and 2 kinds of damage to the brain |
|
Definition
Cardiac
LVH
CAD, Angina, or MI
CHF
CNS
Stroke or TIA
Small vessel ischemia
CKD
Peripheral Artery Disease
Retinopathy |
|
|
Term
|
Definition
1) EKG
2) UA
3) Fasting Glucose or HgA1c
4) Basic Metabolic Panel with measured GFR
5) Fasting Lipid Profile |
|
|
Term
| 5 Lifestyle modifications and effect on HTN |
|
Definition
1) Weight Reduction 5-20/10kg
2) DASH (Low Na High K) 8-14
3) Na Restriction 2-8
4) Physical Activity >150 min/wk 4-9
5) Moderation of Alcohol 2-4 |
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|
Term
Compelling Indications that change first line drugs:
CHF
Post MI
High CAD Risk |
|
Definition
CHF: Thiaz, BB, ACEI, ARB, ALDO ANT (Aldosterone antagonist)
Post MI: BB, ACEI, ALDO ANT
High CAD Risk: Thiaz, BB, ACE, CCB |
|
|
Term
More compelling indications for alternative first line HTN drug:
Diabetes
CKD
Recurrent Stroke Prevention
Osteoporosis |
|
Definition
DM:Thiaz, BB, ACE, ARB, CCB
CKD: ACEI, ARB
Stroke: Thiaz, ACEI
Osteo: Thiaz slows demineralization |
|
|
Term
More compelling indications for alternative first line HTN drug:
BB (4)
CCB (2)
Alpha Blockers (1) |
|
Definition
BB: Tachy arrhytmias, migraine, essential tremor, thyrotoxicosis
CCB: Raynauds and some arrhythmias
Alpha Blockers: BPH |
|
|
Term
HTN Drugs Unfavorable For Comorbidities:
Thiazide (2)
BB (2)
ACEI (2)
ARB (1)
Aldosterone Antagonists (1) |
|
Definition
Thiazide: Gout, Hyponatremia
BB: Asthma, 2nd or 3rd Heart Block
ACEI: Pregnancy, Angioedema
ARB: Pregnancy
ALDO ANT: hyperkalemia |
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|
Term
| This result of HTN on the heart is an independent risk factor for sudden cardiac death |
|
Definition
|
|
Term
|
Definition
Yes
Weight Reduction
Sodium Restriction
All Drug Classes (Except Hydralizine and Minoxidil) |
|
|
Term
Women and HTN:
Oral Contraception
HRT
Pregnant |
|
Definition
OCP Can Raise BP
HRT Does Not
HTN in Pregnancy:
Follow Carefully
Methldopa, BBs, vasodilators (nifedipine) preferred
ACEI, ARB Contraindicated |
|
|
Term
|
Definition
1) Defined as 95th percentile or greater when adjusted for age, height, and gender
2) Drug Therapy only for high levels or failed lifestyle modifications
3) Drug Choices are the same, effective doses are usually smaller
4) Uncomplicated HTN should not restrict activity |
|
|
Term
HTN Urgencies and Emergencies
When to Admit |
|
Definition
Admit only patients with high BP and end organ damage:
Encephalopathy
MI/Unstable Angina
Pulmonary Edema
Eclampsia (Pregnancy)
Stroke
Arterial Bleed/Aortic Disection
If no target organ damage then send home with combination oral medication |
|
|
Term
| What are preferred Beta Blockers in HTN? (2) |
|
Definition
1) Carvedilol (Coreg); Nebivolol (Bystolic)
These Beta Blockers are preferentially vasodilatory |
|
|
Term
| First 4 lines of drugs in HTN |
|
Definition
1) ACE
2) Thiazide
3) CCB or Beta Blocker
4) Spironolactone |
|
|
Term
| Chlorthalidone vs HCTZ (3) |
|
Definition
1) Chlorthalidone is twice as potent as HCTZ
2) Chlorthalidone has superior CV end point reduction
3) Switching from HCTZ to Chlorthalidone improves control |
|
|
Term
| Definition of Heart Failure (5) |
|
Definition
1) Myocardial muscle dysfunction or loss
2) LV dilitation or hypertrophy (pathological remodeling of heart in response to stress)
3) Fluid retention
4) Shortness of Breath
5) Fatigue esp with exertion |
|
|
Term
Severity of Symptoms in Heart Failure
(2) |
|
Definition
1) May vary a lot during course of illness
2) Not necessarily correlated with underlying cardiac function or systolic dysfuntion |
|
|
Term
| Physiology of Heart Failure (2) |
|
Definition
1) Elevated Cardiac Filling Pressure
2) Inadequate delivery of O2 caused by cardiac dysfunction |
|
|
Term
Change in Risk of Heart Failure with Aggressive Treatment of HTN
1) No Comorbidities
2) DM
3) MI |
|
Definition
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