8: Statins & CHF (Quiz W9) Flashcards
Statins
Lowers LDL well
everything else meh
stabilize plaques, reduce MI/stroke risk
Statins SEs
muscle pain, weakness, rhabdomyolysis cognitive dysfxn HA ED ab pain, N, D
Statin CIs
liver dz
pregnancy, lactation
elevated creatine kinase
*avoid with fibrates
Statin Benefit Groups
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
High intensity statin
qd lowers LDL by >50%
Mod intensity statin
qd lowers LDL by 30-50%
Low intensity statin
qd lowers LDL by <30%
Red Yeast Rice
HMG-CoA reductase inhibitor activity
no SEs of statins
may deplete CoQ10
Heart Failure definition
1) inadequate tissue perfusion–> fatigue, DOE, poor exercise tolerance
2) interstitial volume overload–> SOB, rhales, edema
3) intravascular vol overload–>SOB, rhales, edema
HFrEF
EF =40%
systolic HF
HFpEF
EF >/= 50%
diastolic HF
Systolic failure mechanism
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
Systolic failure: “Weak”
decreased EF, increased diastolic P and vol
balloon can’t fill with air, releases it slowly
MI fibrosis, scarred cells
Diastolic failure: “Stiff”
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
Systolic HF Etiologies
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)
Diastolic HF Etiologies
CAD
HTN
aging
microscopic fibrosis/stiffness
(usu elderly and F)
HF sxs
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
HF Management
decrease salt to 2000mg decrease water to 1.5L avoid BB, steroids, alcohol treat arrhythmia, HTN, infxn treat CAD, lung dz, pulm HTN
LHF clinical syndrome
pulm venous congestion (moist crackles, tachypnea, S3)
edema
pulsus alternans
L atria enlargment
Xray- distended pulm venins, perivasc edema
RHF clinical syndrome
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
cor pulmonale
R CHF from chronic lung dz
-PE, COPD, restrictive dz, ventilation/perfusion mismatching
HF labs
BNP> 500
*sensitive but not specific
Blue boaters
Monitor with pulse ox, COPD should not be less than 92% in office
poor alveolar ventilation dt secretions/mucus: at greater risk for hypoxia, benefit more from supplemental oxygen, shunt less.
Pink puffers
Monitor with pulse ox, COPD should not be less than 92% in office
(emphysema) more ominous. They have poor perfusion so even with supplemental ventilation they struggle.
HF Nutrition
CoQ10 Copper D Ribose Folic acid Hawthorne L arginine L carnitine Mag (IV) omega 3 potassium Digitalis...
Digitalis
slows HR, increase force of systolic contrxn
EKG– U shaped downsloping of ST segment, short QT
**best sign for dig= endogenous low BP
cSOC for HFrEF
Lasix, Lanoxin, lying down
K, Mag
ACEi
Systolic HF Tx
ABCDs
ACEi ARB Aldosterone antagonist Abstain alcohol Beta blocker Coumadin Cardiac ionotropes Diuretics (furosemide, spironolactone) Digoxin Diet (low salt)
Diastolic HF Tx
ABCs
ACEi Avoid digoxin Beta blocker CCB Diuretics (furosemide) Diet (low salt)
HF and exercise
EKG monitor without SOB
Pulmonary hypertension (PH)
elevation in the pressure in the arteries of the lungs
Causes:
- OSA
- lung dz
- diastolic HF
- L heart dz
Pulmonary arterial hypertension
disease of the blood vessels of the lungs– vessels have changed causing the elevation in pressure
