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Clin Skills Exam 2 > CAD & Hyperlipidemia > Flashcards

CAD & Hyperlipidemia Flashcards

1
Q

type of lipoproteins within the body
- which are pro-atherosclerotic?

A

lipoproteins
- HDL
- LDL
- VLDL
- Chylomicrons

chylomicrons & LDL & VLDL are atherosclerotic – LDL is the most

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2
Q

indications for obtaining lipid profiles
- AHA/ACC recommendation for when to screen
- pediatrics: when to screen
- USPSTF –> men & women with RF, men & women W/O RF

A

AHA/ACC: screen ALL over the age of 20 for high blood cholesterol

Pediatrics: no clear guidlines on when to screen (consider if high genetic component or family history)

USPSTF
- those with cardiovascular risk factors: screen age 20+
- MEN without risk factors: screen at 35+
- women and men without risk factors ages 20-35: no guidelines
- consider Q5 year tests for low risk
- consdier Q3 year tests for near ot at treatment threshold

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3
Q

what is the goal of screening and obtaining lipid profile levels
(4)

A
  1. identify pts. with HIGH RISK lipid abnormalitlies due to family history
  2. idetify the cause of another condition (ex. pancreatitis)
  3. manage those with established ASCVD
  4. evaluate efficacy of treatment and lifestyle changes
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4
Q

what are the components of a lipid profile

A
  1. total cholesterol
  2. high density (HDL)
  3. low density (LDL)
  4. triglycerides
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5
Q

procedure for ordering a lipid profile
(why fasting?)
how long to follow up post starting treatment?

A

-most commonly order by a PCP
- want a FASTING panel: 8-12 hours of fasting prior to levels drawn
fasting level: because the triglycerides are heavily impacting by meals –> and the TG level goes into the determination of the LDL calculation & ultimate decision of treatment
- follow up 1 week after to discuss labs
- calculate the 10 year ASCVD risk score along with discussion fo lab levels
- primary treatment (lifestyle modification) & secondary (medication)
- re-evaluate after 6-8 weeks post medication

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6
Q

Total Cholesterol Values
- normal
- elevated/boarderline high
- high

A

Normal: < 200 mg/dL
elevated/boarderline: 200-239 mg/dL
High: 240 + mg/dL

high = initiate statin therapy

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7
Q

LDL levels
- optimal
- near optimal
- boarderline high
- high
- very high

what is the level we aim to acheive for those on statin therapy?

A

optimal: < 100 mg/dL
near optimal: 100-129 mg/dL
boarderline high: 130-159 mg/dL

high: 160-189 mg/dL
very high: 190+ mg/dL

Statin Therapy Goal: < 70

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8
Q

equation for measuring LDL from other lipid levels

A

LDL = total cholesterol - HDL - (TG/5)

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9
Q

HDl levels
- do you want low or high
- cut offs

A

want HIGHER HDL –> considered better, as lower levels increase risk fo ASCVD

low: < 40
high: > 60

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10
Q

explian the significance of the HDL to total cholesterol level ratio
- want higher or lower ratio? why?
- what is the equation

A
  • the ratio of total cholesterol to HDl gives a better indication of risk profile for the pt.

TOTAL cholesterol/ HDL = ratio

ex. total = 240 HDl = 68 240/68 = 3.52 (low ratio)

WANT A LOWER RATIO… LOW RATIO = LOW RISK FOR CVD

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11
Q

Triglyceride level ranges
- normal
- mild increase
- moderate increase
- very high

A

normal: < 150 mg/dL
mild increase: 150-499
moderate increase: 500-886
very high: >886 risk for pancreatitis

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12
Q

what are some factors which may interfer with lipid profile numbers? specifically infleucen LDL levels

A
  1. if triglycerides are over 400 this will impact the LDL calculation
  2. high level of chlyomicrons in the blood (becuase chlyomicrons have lots of triglycerides – impacting the LDL calculatio)
  3. family history of type III hypercholesteremia (this condition increases their LDL levels
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13
Q

what is the clinical significance for
- LDL levels
- HDL levels

A
  • higher LDL and low HDl = risk factors for CAD
  • lowering LDL shown to reduce CVD events & mortality
  • HDL levels alone are not a primary prevention target for reducing CAD
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14
Q

course of treatment for primary prevention od ASCVD

Priamry: those who have NOT already had an ASCVD event

  • start high intensity statin when?
  • start moderate for who? with what?
  • consider moderatre for who & with what
A

HIGH INTENSITIY STATIN: begin for those with an LDL level > 190

Moderate intensity statin:
- for those who are 40-75 years with DM & LDL = >70
- for those 40-75 years withOUT DM & LDL = > 70 AND their ASCVD risk score > 7.5%

  • alwasy consider the 10 year ASCVD score & the risk enhancer factors (inflammatory, CKD, metabolic syndrome, family hx.
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15
Q

course of treatment for those with secondary prevention
secondary: those who have HAD a ASCVD event in the past

  • what is our target LDL
  • those with very high risk ASCVD + statin but LDL > 70
  • those on above but LDL > 70 still
A

target LDL: we want our pts. to be on the max. statin tolerated which lowers their LDL by 50%

those with very high risk ASCVD (had the event within past year) & already on a statin & their LDL is still > 70 = add ezetimbie

those on ezetimbie & high risk ASCVD & on statin with LDL > 70 = add PCSK9 inhibitor

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16
Q

what are the cardiac markers?

A
  • enzymes/proteins released from the heart after damange to the heart muscle
  • troponin
  • CK-MB: later phase
  • myoglobin: heme protein : acute phase
  • LDH: lactate dehydrogenase
17
Q

what is troponin
- two types
- when are they high? when are they at peak?
- when do thye return to baseline
- what do they tell use

A

the biomarker of choice for myocardial injury – specfici to the heart (but doesnt tell WHAT happened)

types: cTnI and cTnT (I and T)

  • first detected 2-3 hours after the onset of an acute MI
  • Peak: 24 hours
  • return to baseline: 7-10 days post MI
18
Q

when is troponin indicated?
what are teh criteria for acute MI

A
  1. you suspect an MI – order trops.
  2. other ischemic disease suspects

for acute MI
- ** levels must be above 99th percentile of URL**
- rise and fall of trops. should be observed — trend or serial read
- two high sensitivity trops within 3 hours of arrival are 100% at finding MI
- 80% are found with a single 4th gen test

an elevated troponin does NOT mean an MI
- can be so many other things
- arrythmias, PE, drugs, respiratory failure, sepsis, dissection, aortic valve disease, CHF

19
Q

what is CK-MB?
- when is it used
- where is it found in the body
- when is it elevated
- peak?
- return?

A

creatitine- kinase myocardial band
- orignally used before troponin for MI (now no longer used for MI)
Will be elevated when the heart muscle is damaged (but also elevated when other muscles are damaged— not specific)
- now used for reinfarction assessments (shorter 1/2 life)

found: in tissues (skeletal muscle, heart, brain, etc.)

detected: rising 4-6 hours
peaking: 12-24 hours
return to baseline: 36-48 hours

20
Q

what is CRP
- when is it released

A

C-reactive protein
- acute phase reactant
- NONSPECIFIC biomarker
- increases as a part of the acute phase inflammatory response to various stimuli

any type of inflammation with elevate the CRP!

21
Q

what is the relationship between CRP and Heart Disease?

A
  • CRP will be elevated in inflammatory states –> one of which is atherosclerosis
  • lacks specificity to heart disease
  • significant association between elevated CRP and the presecene of atherosclerosis & therefore indicates risk for a reoccuring CVD event
  • may be helpful for those with boarderline risk of CVD to screen, but no current recommendations
22
Q

what are some factors which interfer with a CRP

A
  • individaul patients themselves!!!
  • gender
  • ethnic group
  • specificifty of the CRP itself
  • comorbid illness (can be elevated for that, not the heart disease)
  • renal failure = increased CRP!
23
Q

what is BNP?
- when is it released & elevated
- what can it help predict

A

B-type natriuretic peptide (brain natriuretic peptide)

  • a hormone normally identified in the brain
  • **released mainly from myocardial cells (specifically ventricles)
  • response to STRETCH of the walls with stress — volume expansion will trigger the release of BNP
  • used as a marker for heart failure and predictor of death
24
Q

indications for the use of BNP? (3)

A
  1. evalulation of dyspnea & heart failure suspected cause
  2. its dieuretic, natriuretic and hypotensive effects
  3. inhibits RAAS, secretion of endothelin & renal sympathetic activity

** BNP is released, like in heart failure, where there is a fluid backup –> the body is trying to REDUCE the amoutn of fluid – thus wants to stop reuptake of solutes and decreased the fluid load**

25
Q

BNP levels & numbers for the diagnosis of HF

A

BNP: < 100 = good rule OUT heart failure

BNP: 100-400 = inconclusive

BNP: > 400 good rule IN for HF

26
Q

factors which may interfer with BNP values

A
  • renal failure (raises BNP)
  • age (increases with age), sex (women have higher) and body mass (obesity = lower)
  • non HF conditions can raise BNP (pulm HTN, sepsis, CHD)
27
Q

N-termial pro BNP
- what is it
- how is it different thatn BNP

A

rises MORE with those who have Left Ventricular dysfunction!!!!

  • ## similar indications for when to order & found in similar concentrations

Clin Skills Exam 2 (6 decks)

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