70 cardio Flashcards
valvular AF vs non valvular? 4
recommend what med for valvular AF?
occurs in the presence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.
non valvular - absence of above
Warfarin
risk factors for AF ? 5
age hypertension, myocardial infarction (MI), congestive heart failure valvular heart disease
NOAC? eg?
not good for what patients?
Non Vitamin K antagonist - dabigatran, rivaroxaban, apixabandibigatron
valvular AF - need warfarin
what does CHADS stand for
Cardiac failure Hypertension, Age, Diabetes, Stroke system
drug of choice for rate control of AF?
BB
non D CCB
* pts has to have no hx of MI, or Lt ventricular dysfunction
when to consider BB over digoxin
BB better for active pts - improves vagal tone (vagal tone is withdrawn during exercise)
Digoxin for sedentary pts
what age to assess for CAD risk
who else at risk? 4
men > 40
women > 50
fam hx
DM
HTN
CKD
first-line intervention for CAD risk?
2nd line tx? reduction of how many %?
lifestyle management
statin after discussion and risk factor management- reduce 30%
adverse affects of statin? 5
when to follow up with initiation of statin?
muscle pain/myopathy , rhabdomyolysis cataracts elevated blood glucose and diabetes acute renal failure and liver injury
4-6 months
CHADS?
when to anticoag with Afib?
Congestive Heart Failure 1 Hypertension 1 Age 75+ 1 Diabetes 1 Stroke - prior stroke or TIA 2 total of 6
if 0 no need for anticoag, unless with Afib and with risk factors and >65
> 1 and have Afib, need to start ASA or OralAntiCoag
significant of Abnormal nocturnal BP differences? puts pt at risk for what?
– an extreme nocturnal BP dip (>20%), non/small nocturnal BP dip (<10%), or an
increase in nocturnal BP are at risk for CVD;
if pt has MI, what meds would you use as first line for BP control?
BB and ACE/ARB
Without specific indications, consider which monotherapy with one of the following first-line drugs: 4
- thiazide diuretic;
- long-acting calcium channel blocker (CCB);
- angiotensin converting enzyme inhibitor (ACE-I; in non-black patients); or
- angiotensin II receptor blocker (ARB).
when would use BB as first line drug for BP
stable angina and >60years
what drugs not recommended together?
ACE and ARBs
non-dihydropyridine CCB
(i.e., verapamil or diltiazem) and a beta-blocker
after start of antihypertensive, when to follow up and with what? and for how long?
2 weeks, and with GFR to monitor kidney fx, then monthly til target reached x 2
review q 3-6 months
Monitor kidney function whenever medications are changed
secondary cause of htn? 9
Aldosteronism - hypokalemia
hyperparathyroidism
hyper/hypo thyroidism
coarct
oral contraception
Pheochromocytoma - adrenal hormones cause htn
Cushings
Kidney disease
Sleep apnea
eg of
BB
Calcium Channel Blocker
Non - DHP
ARBS
BB - lol, metoprolol, bisoprolol
CCB - pines, amlodipine, nifedipine
Non - DHP - verampramil, diltiazam
ARBS - artan - candesartan, losartan
when to take bp?
what values to seek immediate tx?
Patients aged ≥ 45 years, record BP at least once every 5 years.
any time diastolic BP is > 130 or BP is > 180/110 with signs or symptoms,
When to diagnosis hypertension? 2
, if:
o ambulatory or home BP monitoring indicates an elevated BP; or
o elevated BP at a 3rd office visit.
When a consultation with a specialist indicated? 4
Hypertensive emergency;
sudden onset in the elderly; abnormal nocturnal BP differences;
signs or symptoms suggesting of secondary causes of hypertension;
and if BP is difficult to control after treating with 3 antihypertensive medications.
what is considered mild HTN?
what does life style change include? 6
Recommended for mild hypertension (average BP = 140-159/90–99), low-risk for CVD and have no co-morbidities.
• It includes: 1 smoking cessation, 2 increasing physical activity, 3 obtaining or maintaining a healthy body composition, 4 eating a well-balanced diet, 5 moderate alcohol consumption and 6 monitoring salt intake.
what is a major risk factor in women to have early onset of ischemic heart disease?
DM
questions to ask anyone who has angina like pain? 5
pain greater than 20 minutes? crescendo pattern? occurs at rest or at night? severity with activity? new onset? dyspnea?
