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Cardio <3 > 8: Statins & CHF (Quiz W9) > Flashcards

8: Statins & CHF (Quiz W9) Flashcards

1
Q

Statins

A

Lowers LDL well
everything else meh

stabilize plaques, reduce MI/stroke risk

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2
Q

Statins SEs

A 
muscle pain, weakness, rhabdomyolysis
cognitive dysfxn
HA
ED
ab pain, N, D
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3
Q

Statin CIs

A

liver dz
pregnancy, lactation
elevated creatine kinase

*avoid with fibrates

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4
Q

Statin Benefit Groups

A

1) Individuals with clinical ASCVD to prevent MI or stroke
2) LDL–C ≥190 mg/dL
3) 40 to 75 years of age with DM and LDL–C 70 to189 mg/dL without clinical ASCVD
4) No ASCVD or DM, 40-75 age with LDL–C 70 to 189 mg/dL and have an estimated 10-year
ASCVD risk of 7.5% or higher

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5
Q

High intensity statin

A

qd lowers LDL by >50%

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6
Q

Mod intensity statin

A

qd lowers LDL by 30-50%

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7
Q

Low intensity statin

A

qd lowers LDL by <30%

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8
Q

Red Yeast Rice

A

HMG-CoA reductase inhibitor activity
no SEs of statins
may deplete CoQ10

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9
Q

Heart Failure definition

A

1) inadequate tissue perfusion–> fatigue, DOE, poor exercise tolerance
2) interstitial volume overload–> SOB, rhales, edema
3) intravascular vol overload–>SOB, rhales, edema

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10
Q

HFrEF

A

EF =40%

systolic HF

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11
Q

HFpEF

A

EF >/= 50%

diastolic HF

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12
Q

Systolic failure mechanism

A

sys failure–> decreased CO
kidneys interpret as low vasc vol activating RAAS
increased intravasc vol –> increased preload–> BNP
increased sympathetic stimulus –>increased preload and afterload–>weak systole–>further decreased CO

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13
Q

Systolic failure: “Weak”

A

decreased EF, increased diastolic P and vol
balloon can’t fill with air, releases it slowly
MI fibrosis, scarred cells

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14
Q

Diastolic failure: “Stiff”

A 
elevated diastolic P
balloon with THICK rubber, fills with high P but volume can't expand
increased pulm venous P
SOB
pulmonary edema
backward failure
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15
Q

Systolic HF Etiologies

A 
CAD: ischemic cardiomyopathy
HTN--LVH
Afib
Metabolic (alcohol cardiomyo, post partum, thyroid dysfxn)
acute stress cardiomyo
viral, infectious, idiopathic
pericarditis, tamponade
restrictive cardiomyo
valvular dz
congenital malformation

(usu 50-70 and M)

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16
Q

Diastolic HF Etiologies

A

CAD
HTN
aging
microscopic fibrosis/stiffness

(usu elderly and F)

17
Q

HF sxs

A 
dyspnea (interstitial pulm edema)
orthopnea (increased preload)
PND
Cheyne stokes respiration
acute pulm edema--frothy sputum, cough
displaced apical pulse
JVD, hepatojug reflux, rales/crackles, peripheral edema, ascites
nocturia/oliguria
S3
18
Q

HF Management

A 
decrease salt to 2000mg
decrease water to 1.5L 
avoid BB, steroids, alcohol
treat arrhythmia, HTN, infxn
treat CAD, lung dz, pulm HTN
19
Q

LHF clinical syndrome

A

pulm venous congestion (moist crackles, tachypnea, S3)
edema
pulsus alternans
L atria enlargment
Xray- distended pulm venins, perivasc edema

20
Q

RHF clinical syndrome

A 
venous congestion, JVD >3cm
lower extremity edema
abdominal ascites
pulmonary rales
R sided EKG
CXR changes-cephalization, hilar butterfly pattern rales, Kerley B lines, blunting of costophrenic angle
Kussmaul's sign
hepatojug reflux, ascites, pitting edema
21
Q

cor pulmonale

A

R CHF from chronic lung dz

-PE, COPD, restrictive dz, ventilation/perfusion mismatching

22
Q

HF labs

A

BNP> 500

*sensitive but not specific

23
Q

Blue boaters

Monitor with pulse ox, COPD should not be less than 92% in office

A

poor alveolar ventilation dt secretions/mucus: at greater risk for hypoxia, benefit more from supplemental oxygen, shunt less.

24
Q

Pink puffers

Monitor with pulse ox, COPD should not be less than 92% in office

A

(emphysema) more ominous. They have poor perfusion so even with supplemental ventilation they struggle.

25
Q

HF Nutrition

A 
CoQ10
Copper
D Ribose
Folic acid
Hawthorne
L arginine
L carnitine
Mag (IV)
omega 3
potassium
Digitalis...
26
Q

Digitalis

A

slows HR, increase force of systolic contrxn

EKG– U shaped downsloping of ST segment, short QT

**best sign for dig= endogenous low BP

27
Q

cSOC for HFrEF

A

Lasix, Lanoxin, lying down
K, Mag
ACEi

28
Q

Systolic HF Tx

ABCDs

A 
ACEi
ARB
Aldosterone antagonist
Abstain alcohol
Beta blocker
Coumadin
Cardiac ionotropes
Diuretics (furosemide, spironolactone)
Digoxin
Diet (low salt)
29
Q

Diastolic HF Tx

ABCs

A 
ACEi
Avoid digoxin
Beta blocker
CCB
Diuretics (furosemide)
Diet (low salt)
30
Q

HF and exercise

A

EKG monitor without SOB

31
Q

Pulmonary hypertension (PH)

A

elevation in the pressure in the arteries of the lungs

Causes:

  • OSA
  • lung dz
  • diastolic HF
  • L heart dz
32
Q

Pulmonary arterial hypertension

A

disease of the blood vessels of the lungs– vessels have changed causing the elevation in pressure

Cardio <3 (9 decks)

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