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BB better for active pts - improves vagal tone (vagal tone is withdrawn during exercise)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?
if pt has ‘chest pain’ and hypotentisve think?
cp and asymmetrical bp?
PE - cause pressure all in the lungs leads to systemic hypo
aortic dissection
