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Cardio <3 > 5: CAD Tx & Infectious (Quiz W6) > Flashcards

5: CAD Tx & Infectious (Quiz W6) Flashcards

1
Q

Optimize blood viscosity

A

nattokinase
proteolytic enzymes
gingko

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2
Q

Decrease platelet aggregation

A 
fish oil
gingko
garlic
nattokinase
aspirin
plavix (clopidogrel)
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3
Q

Chelation therapy MOA

A

EDTA chelates Pb and other metals, REMOVES Ca from walls of blood vessels, improves circ

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4
Q

Chelation therapy IND

A

CAD, arteriosclerosis, arrhythmias, chronic lung dz, OA

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5
Q

Chelation therapy CI

A

renal failure, acute kidney infxn, TB, unstable CHF, thrombocytopenia

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6
Q

Chelation therapy labs

before initiating therapy

A

CMP (BUN and creatinine)

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7
Q

Cayenne pepper

A

MOA: lowers BP, improves circ, aids in chelating arterial plaque, reduces cholesterol absoprtion

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8
Q

Magnesium

A

“ND calcium channel blocker”, vasodilator

Mag glycinate is best

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9
Q

Arginine MOA

A

releases into NO, given with gamma tocopherol to reduce nitric oxide free radicals

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10
Q

Arginine IND

A

HTN, CAD, erectile dysfxn

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11
Q

Arginine CI

A

herpes, chronic viral illness, COPD (pro-inflamm to lung epithelium)

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12
Q

Hawthorne MOA

A

high in OPCs, strenghtens cardiac output, vasodilator, mild ACE-i action

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13
Q

Hawthorne IND

A

high cholesterol, CHF, CAD, post MI, HTN

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14
Q

Hawthorne CI

A

high output states (e.g. hyperthyroid)

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15
Q

Grape Seed Extract MOA

A

vasodilator, platelet agg inhibitor, improves small vessel disease

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16
Q

Decrease elevated lipids: Diet for ___

A

xxx

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17
Q

Decrease elevated lipids: Diet for ___

A

ccc

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18
Q

Nicotinic acid MOA

A

lowering total cholesterol/TGs and raising HDL levels
decreases LDL and LP(a)
increases large, buoyant LDL

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19
Q

Nicotinic acid: reduces mortality in…

A

secondary prevention trials

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20
Q

Niacin adverse effects

A

flushing, itching, GI complaints, weakness

LONG term AEs: hepatoxicity, hyperuricemia, glucose intolerance, ocular disturbance, ulcers, postural hypotension

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21
Q

Niacin Labs to follow up

A

uric acid, liver enzymes, lipid fractionation

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22
Q

Guggulipid IND

A

lowers total cholesterol/TGs, may increase HDL

decreases LDL

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23
Q

Guggulipid MOA

A

enhanced excretion, inhibition of cholesterol syn, increased hepatic binding sites for LDL

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24
Q

Red Yeast Rice

A

HMG CoA reductase inhibitor

can deplete CoQ10

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25
Q

Garlic

A

co-admin with fish oil–benefits lipids and lipoproteins
decrease total cholesterol, LDL-c
decrease TC:HDL and LDL:HDL

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26
Q

Phytosterols

A

decreases gut absorption of cholesterol
sunflower, flax, salba seed
(and to tx BPH)

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27
Q

Policosanol

A

modulates HMG CoA reductase

positive effects on platelet function, BP, lipid peroxidaton

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28
Q

Fish oil

A

hypolipidemia, hypotensive, antithrombotic

decrease total cholesterol, LDL, TGs, increase HDL

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29
Q

CoQ10 MOA

A

improves myocardial fxn

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30
Q

CoQ10 IND

A

CHF, hyperlipidemia, elevated Lp(a), angina/CAD, cardiomyopathy

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31
Q

pantethine IND

A

elevated TGs

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32
Q

Tx to decrease homocysteine

A

diet, B vitamins, SAM-e

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33
Q

Carnitine

A

improves myocardial O2 supply in angina, promotes remodeling of L ventricle, lowers TGs

IND: post MI, MVP, cardiomyopathy, CHF

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34
Q

Proline

A

MOA: lowers BP, aids in CT repair

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35
Q

Taurine MOA

A

reduces arrhythmias dt cardiac def, positive ionotrope

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36
Q

Taurine IND

A

CHF, CAD

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37
Q

Taurine CI

A

hyperdynamic L ventricle (pregnancy, hyperthyroid)

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38
Q

CABG limitations

A

25% rehospitalized in 3 mos of original surgery
high restenosis rate
complications- wound infxn, Afib, pleural effusion, thromboembolic event, cognitive decline

(CABG safer than stents)

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39
Q

Angioplasty with stent cautions

A

sequallae: post-stent thrombosis, foreign object rxns (worse with drug eluting stent)

pts need plavix 6mos-life

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40
Q

Angioplasty with stent morbidity/mortality changes

A

relieve chest pain

*Stents are used to improve quality of life, improve exercise tolerance, NOT increase life expectancy

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41
Q

Post Stent Meds

A

Plavix
Statins
ACE-i–reduce preload and afterload
Beta blockers–reduce rate, improves survival rate

42
Q

Nitro

A

L sided MI ONLY (CI in R)
also give gamma tocopherol to quench nitric peroxide free radicals when on nitro, isosorbide mononitrate, smoked meat diet

43
Q

ALL protocol

A

Aspirin
Lisinopril
Lovastatin

*given to pts with DM to reduce MI, stroke, costs, mortality

44
Q

Natural alternatives to ALL

A

nattokinase, hydro, policosanol

fish oil, hydration, niacin/sterols

45
Q

BALL protocol

A

Beta blocker
Aspirin
Lisinopril
Lovastatin

CAD tx for early stage/non surgical pts

46
Q

Acute Rheumatic Fever

A

sequalae from untx strep (less than 3%)

47
Q

ARF PE and Labs

A

new murmur

Anti DNase B Ab titerstrep test (IN in ACUTE infxn)
ASO titer
ESR
WBC

48
Q

Modified Jones Criteria

A

MAJOR:

  • migrating polyarthritis
  • carditis, valvulitis
  • CNS involv
  • subQ nodules
  • ertyhema marginatum

MINOR

  • arthralgia
  • fever
  • elevated ESR/CRP
  • prolonged PR interval
49
Q

ARF Diagnosis

A

2 Major criteria + 1 minor

50
Q

ARF Sequalae and prognosis

A

Chronic RHD
damage to heart valves

Prog: depends on initial infxn, reactivation leads to permanent heart damage

50% do not manifest cardiac involvement until yrs later

51
Q

ARF Conventional TX

A

Abx for GAS: 10 days penicillin (or cephalosporin or macrolides)

TX asx household
aspirin for carditis and arthritis
TX the HF
pt remains on Abx prophylaxis

52
Q

ARF Naturopathic TX

A

To tx GAS, but no research about treating RHD

53
Q

Rheumatic Heart Dz

A 
may not present for 10-20 yrs after initial illness
#1 cause acquired heart dz
54
Q

RHD Pathophys

A

inflmmatory changes –thickening, fibrosis that derange the mitral and aortic valves

55
Q

RHD PE

A

mitral stenosis
aortic regurg
aortic stenosis later

56
Q

RHD Conventional Tx

A 
NSAIDs
glucocorticoids
immunosupp
eridication of infxn
secondary prevention of reactivation
57
Q

Endocarditis

A

infectious

  • subacute
  • acue
  • prosthetic valve

non-infectious

  • SLE
  • CA
  • DIC
58
Q

Infectious endocarditis pathophys

A

initial activation- adherence of thrombus/microbe, then covered in platelets and fibrin

-s aureus, s viridans

59
Q

Infectious endo RFs

A

congential heart defects, RHD, congenital bicuspid, calcified valces, MVP, cardiomyopathy, prosthetic valve

60
Q

Subacute endocarditis

A

S viridans.

insidious, slow progression, no indentifiable portal of entry

61
Q

Acute endocarditis

A

S aureus.

ACUTE, rapid, obvious portal

62
Q

Infectious endo sxs

A 
Fever
Roth spots
Osler Nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Embolic phenomena
63
Q

Infectious endo DX: Modified Duke Criteria

A

path evidence (blood culture)
imaging/echo
clinical signs
Hx

64
Q

Infectious endocarditis seq

A

HF= mortality (100% untx)

65
Q

Infectious endo TX

A

IV Abx

prophylaxis with RFs

66
Q

Pericarditis pathophys

A

infection, trauma, post CABG, auto-immun, mets, drugs

67
Q

Acute pericarditis etio

A

viral: 90% of infxs!

- herpes, HIV, Coxsackie, Echovirus

68
Q

Acute pericarditis sxs

A

severe substernal pain, radiates to back
WORSE inspiration, worse lying supine
better leaning forward
tachycardia, fever

69
Q

Acute pericarditis PE

A 
pericardia rub (HIGH specificity)
tachycardia
70
Q

Acute pericarditis seq

A

pericardium can accommodate 120cc but > causes cardiac TAMPONADE
-hypotension, JVD, pulsus parodoxus, distant heart sounds*, narrowed pulse P

*Becks triad

Tx for tamponade: pericardiocentesis

71
Q

Acute pericarditis Labs

A 
ESR, CRP, WBC
EKG (ST Segment elevation, PR dep, low QRS)
CXR (cardiomeg, water bottle shape)
Echo
*CT with contrast
72
Q

Acute pericarditis versus MI

A

MI: S4, local ST elevation

pericarditis: ST elevated in all leads, friction rub

73
Q

Acute pericarditis TX

A

tx etiology, NSAIDs, maybe pericardiocentesis

74
Q

Constrictive pericarditis

A

fibrotic thickening with adhesions and Ca depositions

etio: CT dz, radiation to chest

75
Q

Constrictive pericarditis sxs

A

pericardial knock (diastole)
JVD, rising during inspiration- Kussmaul
ECG: low QRS
Afib in 1/3 cases

76
Q

Constrictive pericarditis TX

A

rest, salt restriction, diurectics

resection of pericardium

77
Q

Aortic Stenosis Etiology

A

50% have CAD

#1. Calcified stenosis: unfused, stiff, obstruction variable and progressive
#2. Bicuspid aortic valve: one of the most common adult congenital heart disease, congenitally fused   leaflets
#3.  Rheumatic disease (from Rheumatic Fever): fused leaflets, obstruction fixed and progressive
78
Q

Aortic stenosis versus sclerosis

A

Aortic sclerosis: valve leaflet thickening without obstruction to flow

Aortic stenosis: valve leaflet thickening WITH left ventricular outflow tract obstruction

79
Q

AS sxs

A 
angina
exertional dyspnea/lightheadedness
syncope
CHF
arrythmia
80
Q

Aortic Stenosis sxs

A

murmur: systolic cresc-decresc, lean forwrad and radiates to clavicle

BEST HEARD in R sternal border, radiates to carotids

augment with squatting

parvus et targus pulse

81
Q

Aortic Stenosis Labs

A

ECG: LVH, LV strain pattern with systolic overload (ST depression, T wave inversion ), LBBB
CXR: may show calcification in the valave
Trans thoracic echo: confirms dx
Significant AS:
Valve area < 0.7 cm
Valve gradient > 50 mm Hg

(Coronary angiography: for preop)

82
Q

Aortic valve replacement

A

porcine-less likely to cause thrombosis and embolism

REQUIRED with ssxs, S4 sound, valve area < 0.7 cm, peak aortic gradient is > 50 mm Hg

83
Q

Aortic Sclerosis

*most common cause of aortic stenosis

A

Atheroslcerotic degeneration of a congenitally normal valve
Less RISKy than other types of AS
PE: Can hear S1 and S2, early systolic murmur
(Vs. stenosis: can obscuring S1, longer duration)

84
Q

Aortic Regurg RFs

A

rheumatic fever, infectious endocarditis, congenital bicuspid valve, syphilis, myxoma, idiopathic valve degeneration

85
Q

Aortic Regurg Sxs

A

Fatigue and weakness, dyspnea on exertion, syncope, orthopnea,
Wide pulse pressure, low diastolic BP
Head bobbing “yes-yes” sign (dt wide pulse pressure)
Bounding arterial pulse in the neck
Bisfirens pulse
Subungual pulsations under their fingernails from large stroke volume

**Low diastolic BP + diastolic murmur in aortic region = aortic regurg until it is ruled out

86
Q

Aortic Regurg Murmur

A

“to fro” murmur
early diastolic, high pitched, BLOWING
pt lean forward, hold breath
loudest in L 3/4 interspace

87
Q

Aortic Regurg Imaging

A

ECHO to confirm and measure aortic root dilation
CXR: boot shape heart due to LV dilatation
ECG: LVH

88
Q

Aortic Regurf Tx

A

avoid strenuous exercise

Rule of 55 for replacement: EF <55% + LV dimension >55mm

89
Q

Aortic Regurg Seq

A

Acute regurg CRISIS=

  • due to dissection, trauma, endocarditis
  • may cause pulmonary edema
  • sxs: new onset AR murmur, sxs of LCHF
90
Q

Myocarditis

A

commonly viral-
parvo B19, HHV-6
peds: Coxsackie, echovirus, adenovirus

seq: dilated cardiomyopathy

91
Q

Takayasu Arteritis

A

vasculitis of aorta and branches

F 80-90%

92
Q

Takayasu Arteritis pathophys

A

immunologic with lymphocytes, macrophages, giant granulomatous inflammation in the media

SEQ: vessel dilation, aneurysm, stenotic occlusions

93
Q

Takayasu Arteritis sxs

A 
subclavian steal in arms
cool extremities
HTN
chest pain, MI, angina
aorta dilation, AR, HF
dyspnea, hemoptysis, pulmonary HTN
94
Q

Takayasu Arteritis Diagnostic criteria

3/6

A 
<40 yrs onset
claudication in legs,
systolic BP difference >10mmHb bet arms
subclavian, abdominal bruits
diminished brachial pulses
arteriographic narrowing of aorta
95
Q

Takayasu Arteritis Conventional Tx

A

steroids
immunosuppressive
revasc of stenotic vessel
aortic valvuloplasty

96
Q

Kawasaki Disease sxs

A

tachycardia, fever, hyperdymanic precordium
S3 gallop
angina
syncope

97
Q

Kawasaki Dz Diagnostic Criteria

A

FUO 5+days plus 4/5:

  • Conjunctivitis
  • Cerv LAD
  • Oral mucosal changes (strawberry tongue, etc)
  • Non-vesicular, polymorphous rash
  • Erythema/edema of palms/soles
98
Q

Kawasaki Dz Labs

A 
ESR, CRP, leukocytosis with L shift
reactive thrombocytosis
anemia
pyuria
CSF abnormalities
99
Q

Kawasaki Dz Seq

A

ischemia, infaction, myocarditis, cardiomyopathy, HF
coronary a aneurysms, MR or AR
atherosclerosis

100
Q

Kawasaki Dz Conventioanl Tx

A

IV IG
steroids
anticoagulants

Cardio <3 (9 decks)

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