Cardiac Flashcards
Best drug to lower LDL?
Side fx?
STATIN —| HMG CoA Reductase
Fx: hepatotoxicity,myositis
Drug to lower LDL & Raise HDL but causes flushing…
How do you prevent this side fx?
Niacin –| HSL in fat, decreasing FFA transport
Fx: flushing!, hepatotoxicity
Prevent flushing with asprin!
Best drug to lower total cholesterol? Side fx?
Fibrates –> PPAR-a agonist = increases lipolysis, raising HDL & lowering TC
Fx: gallstones, myositis
Lipid drug that causes diarrhea, constipation, gallstones & bloating? Mechanism of action?
Resins –> increases secretion of bile acids in GI resutling in decreased LDL
Drug that blocks the absorption of cholesterol in the intestines? Fx?
Ezetimibe = decreases LDL
Fx: myositis, contipation, bloating, diarrhea
Who gets a statin?
- Vascular disease
- LDL >/= 190
- LDL 70-189 + 40-75yoa +DM or 10yr risk
- LDL 70-189 + 40-76 w/calculated risk
How often do you check lipids in a person on a statin or w/hypercholesteremia?
ANNUALLY!
*dont need to check liver shit unless symptoms
SIRs Criteria requires 2+ of….
- Temp >38 or <34
- HR >90
- RR>20 or PaCO2 <32
- WBC >12000 or <4000 or >10% bands
How often do you screen for cholesterol levels?
35q5
Screening for osteoporosis?
> 65
Breast cancer screening?
50q2 till 75
Cervical cancer screening?
21q3 till 75
HTN screening?
18q2
Tx of SIRs?
- Give 30cc/kg bolus IVF
- Remove sources of infection
- O2 as needed
- Pressers of bolus fails
- Empiric abx
Treatment fo HF for EVERYBODY?
<2g of salt per day, <2L H2O per day, ACE/ARB, BB
Tx for reducing preload in HF pt…which type needs a reduced preload?
Diuretics(furosemide), Nitrates, Dietary modifications.
*usually diastolic needs this
Diastolic heart failure etiology
FILLING FAILURE due to Pericardium(tamponade, constrivie pericarditis) or Cardiomyopathy(restritive or hypertrophic)
Systolic HF etiology
FORWARD failure due to Leaky valves(regurge), Dead heart(ischemia/infarct), floppy muscles(HTN, EtOH, Drugs)
NYHA classifications of HF…
1: no limitations, no sx
2: slight limitation, comfortable at rest and walking
3: Moderate, comfortable at rest only
4: bed bound, sxs at rest
Tx for reducing afterload in HF pt….who needs this?
usually needed by systolic failure
- ACE/ARB, Hydralazine, Spironolactone
When do you use inotropes like dobutamine in HF?
once they reach class 4 = bed bound w/sxs at rest
Who gets anticoagulated?
Ppl with a score of 2 on CHAD2(CHF, HTN, age>/=75, DM or previous stroke or TIA(2pts)). A fib with out these RF = no anticoagulant
CHAD = 1 use ASA only
40 yo male w/2 wks fever, malaise, wknes, weight loss, L sided chest pain + ab pain. decrease lung sounds + dullness in L lower. 2/6 systolic murmer. L sided pleural effusions, splenomegaly w/splenic fluid. dx?
Infectivie endocarditis causing splenic abscess
Prob due to staph or strep
Drug user who now has Fever, cough + some endocarditis. MC endocardiits? what murmer would you hear?
Tricupid due to Staph Aureus = triscupid regurge = holosytolic murmer that increases with inspiration
What heart shit is atropine used for?
Bradycardia and 1 degree av block
What heart shit is adenosine used for?
SVT >150
What heart shit is mg used for?
Torsades
What heart shit is amiodarone used for?
Torsades and vtach *can also use lidocaine
What heart shit is used for stable afib?
CCB(diltiazam), BB, digoxin = rate control
Which heart shit gets worse with leg raise/squat and better with valsalva/standing ?
Mitral stenosis, aortic stenosis, mitral regurg and aortic regurg
How do you treat hypertrophic cardio myopathy
Avoid dehydration and give beta blockers
How do you treat restrictive cardiomyopathy? What would you see on echo?
Look for dilated atrium and hypertrophic ventricles. Treat with gentle diuresis
How do you treat heart failure?
LMNOP = Lasix, morphine, oxygen, nitro, position
What heart defect will remain a fever cause? What can this lead you down the road?
Mitral stenosis which can eventually present as atrial fib you Laois and’s and should be treated with rate controlled via calcium channel blocker‘s beta blockers or digoxin
Respiratory variation in systolic bp(pulses paradoxus), hypotension, tachycardia, jvd + widener mediastinum. Dx?
Cardiac tamponad = pericardial fluid accumulation