Cardiovascular

Question 1

Treatment of abdominal aortic aneurysm’s

Answer 1

Patients with large aneurysms –5.5 cm or larger should undergo surgical repair

Question 2

Two calculations to use in determining the need for anticoagulation in Afib and assessing the bleeding risks

Answer 2

CHA2DS2VASc don’t treat in men of 0 and women score of 1, in general treat males with 2 or higher and females with 3 or higher. HAS-BLED score 3 or higher is risky and can use DOAC score as well.

Question 3

Best treatment for elevated triglycerides, elevation is levels between 150 and 500. Over 500 equals severely elevated triglycerides

Answer 3

Lose 5% body weight
Lowering carbohydrates especially refined carbohydrates. Increasing fats especially omega-3 fatty acids and increasing protein.
Exercise
Add statin if intermediate risk or greater
Add fibrates if TG >500

Question 4

What are the levels of 10 yr ASCVD risk, using the calculator

Answer 4

Low is <5%
Borderline is 5-7.5%
Intermediate is 7.5-19.9%
High is >20%

Question 5

Primary prevention with statins. When to use them. What doses.

Answer 5

Patients with a 10 year risk ASCVD 12% or greater should be on moderate intensity Statin for adults over 40 years old, patients between 6 and 12% should have shared decision making.

Secondary prevention patient should be at least on moderate intensity Statin titrating up to high intensity. Patients with LDL cholesterol 190 or greater should also consider treatment in spite of their 12 year risk factor

Question 6

How do PCSK9 Inhibitors like repatha and Praluent work

Answer 6

They inhibit PCSK9 action that absorbs and reduces the LDL-R on cell surface of hepatocyte. Thereby increasing the LDL-R and clearing more LDL from blood stream.

Question 7

What is the cardiac defect in Marfan syndrome

Answer 7

Aortic insufficiency 80–100% of these lead to aortic root dilation
Mitral valve prolapse

Question 8

Who needs an ABI

Answer 8

anyone >65, Age 50-64 with CAD, Tob use, DM, HLD, HTN, FH of PAD, Age <50 with DM and one other risk factor. (obese, HTN, Tob, HLD, CAD)

Question 9

grading and staging of heart failure

Answer 9

Grade A,B,C,D
Grade A risks
Grade B structural changes no sxs
Grade C Structural and sxs
Grade D Advanced sxs, impactful, refractory to tx

for Grade C-D
NYHA Stage I,II,III, IV (functional Status)

Question 10

Describe EF% and how to describe?

Answer 10

Characterization by left ventricular ejection fraction (LVEF) is primarily relevant in stages C and D. Therapy can be tailored by LVEF ranges.

LVEF of 50% or more is classified as preserved.

LVEF of 41% to 49% is classified as mildly reduced. Most patients in this range have a different ejection fraction at the next evaluation.

LVEF of 40% or less is classified as reduced.

LVEF that has improved from 40% or less to greater than 40% is classified as improved.

Question 11

Tx options for pt for different stages

Answer 11

Stage A (no symptoms): SGLT-2
Stage B (Pre HF): ACE / ARB, Pts with hx of MI or ACS should be on Beta Blocker
Stage C:

Question 12

Tx of Heart Failure:

Answer 12

Question 13

When to test and what to check for suspected Heart Failure?

Answer 13

watch for signs of orthopnea, SOB, Edema, SOB with bending down,
Test EKG, BNP, Chest Xray, If concerning order an ECHO

Question 14

ASCVD risk factors

Answer 14

HTN, HLD, DM, CKD, Tob Use, Obesity, Fam Hx of HLD, Fam Hx of CVD

Question 15

who should have a 10 year CVD risk assessment?
who should be treated with statin?
who should start aspirin thereapy?

Answer 15

Pts 40-75,
Pts with lifetime risk of >39% should be treated aggressively statins
depends, 10 yr risk >20% or lifetime risk >39% probably yes

Question 16

what are the four areas in ASCVD refer to?

Answer 16

●Coronary heart disease (CHD) manifested by fatal or nonfatal myocardial infarction, angina pectoris, and/or heart failure

●Cerebrovascular disease manifested by fatal or nonfatal stroke and transient ischemic attack

●Peripheral artery disease manifested by intermittent claudication and critical limb ischemia

●Aortic atherosclerosis and thoracic or abdominal aortic aneurysm

Question 17

why worry about statins in heart failure?

Answer 17

CAD is still one of the biggest risk factors for the development of diastolic and systolic heart failure.

Question 18

Describe the EKG pattern in LBBB?

Answer 18

The ECG features of the QRS complex which define LBBB in adults include QRS duration greater than or equal to 120 ms; broad notched or slurred R wave in leads I, aVL, V5, and V6 and an occasional RS pattern in V5 and V6; absent q waves in leads I, V5, and V6; R peak time greater than 60 ms in leads V5 and V6 but normal in leads V1, V2, and V3; and ST and T waves usually opposite in direction to QRS complex

Question 19

Give these 3 things to everyone with ACS?

Answer 19

Dual Anti platelet (aspirin, P2Y12 inhibitor) and anticoagulant
If STEMI give thrombolytics

Question 20

How do PCSK9 inhibitors work?

Answer 20

PCSK9 binds to LDL receptors and causes them to degrade in the cell. The inhibitors like purulent, and Repatha bind to PCSK9, and prevent it from binding onto the LDL receptor. Therefore LDL receptors are not degraded. The more LDL receptors the liver cell has the more cholesterol it will clear from the bloodstream 

Question 21

How do statins work?
what is the most lipophilic and the most lipophobic statin?

Answer 21

HMG,coA reductase inhibitors, which reduces cholesterol inside the liver cell, which causes more LDL receptors and clearing of more cholesterol from the bloodstream
The most lipophilic is going to be Lipitor in the most lipophobic is going to be Crestor

Question 22

How does cocaine cause chest pain?
How do you treat chest pain with someone? who has suspected cocaine usage

Answer 22

Cocaine causes coronary constriction by shutting off nitric oxide and also causes vasospasms because of alpha adrenergic receptor stimulation of smooth muscle.
Treat this with benzos to help relax central stimulation. Also with Nitroglycerin. to help relieve the vasoconstriction.

Question 23

What is Wellen’s syndrome on an EKG?

Answer 23

It can represent stenosis., without. narrowing such as cocaine use. Very deep inverted T waves in V2 and V3. represents narrowing of the LAD

Question 24

Should you add slow release niacin to a statin if we are trying to lower triglycerides and raise HDL?

Answer 24

2011 trial found no clinical benefit from adding sustained-release niacin to a statin in patients with known coronary heart disease and a low HDL-cholesterol level.

Question 25

Absolute contraindications to exercise stress testing.

Answer 25

Absolute contraindications to exercise testing include:
acute myocardial infarction within the previous 2 days,
unstable angina,
cardiac arrhythmias causing symptoms or hemodynamic compromise,
severe aortic stenosis,
symptomatic decompensated heart failure,
acute pulmonary embolism or infarct,
acute endocarditis, pericarditis or myocarditis,
acute aortic dissection.

Patients must be able to walk briskly on the treadmill,

Question 26

When should you perform a coronary calcium score?

Answer 26

Patients between 40 and 55 who are at intermediate risk with a 10 year CVD risk between 5% and 20%.. patients who do not have diabetes or smoke.

Main purpose is to see if someone should be on statin therapy when that. decision is not clear.

Question 27

nonischemic conditions that are associated with elevated cardiac troponin levels?

Answer 27

-heart failure,
-pulmonary disease or pulmonary embolism,
-chronic kidney disease,
-sepsis and severe infection,
-chemotherapy-associated cardiac toxicity,
-myocarditis,
-severe acute neurologic disease such as stroke or subarachnoid hemorrhage, -infiltrative diseases such as amyloidosis and sarcoidosis

Question 28

Stress test is unreliable in LBBB and these pts should have what?

Answer 28

Stress Echo

Question 29

People at risk for statin induced myalgias?

Answer 29

> 80yr, Hypothyroid, Liver or kidney dz, concurrent use of fibrates
C0-Q10 not recommended
overall risk is only 5-10%

Question 30

Risk of giving someone nitro for angina if they have taken ED meds?

Answer 30

-Administration of nitrates in close proximity to the use of a phosphodiesterase-5 (PDE-5) inhibitor has been associated with profound hypotension, myocardial infarction, and even death.
-24 hrs for short acting and 48 hrs for long acting PDE-5

Question 31

How to check for pulses paradoxus?

Answer 31

This is when BP drops >10mmHg with inspiration. Listen and record the first Korotkoff sound using stethoscope and BP cuff. Then record the BP reading when the sound no longer disappears with inspiration

Sign of Cardiac tamponade

Question 32

Symptoms of aortic dissection?
Who is most at risk?

Answer 32

The chest pain of aortic dissection is typically described as searing, ripping, or tearing, and frequently radiates to the back or may radiate to the lower extremities. The pain is worst at the time of onset and lasts for hours.

Advanced age, male sex, a long-term history of arterial hypertension, and the presence of an aortic aneurysm confer the greatest population-attributable risk. However, patients with genetic connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome, or Ehlers-Danlos syndrome, and patients with bicuspid aortic valves are at increased risk of aortic dissection at a much younger age.

Question 33

When you must use warfarin over a DOAC

Answer 33

Warfarin is the only oral anticoagulant recommended for the treatment of AF in patients with moderate to severe mitral stenosis or a mechanical heart valve

Question 34

What are the 10 yr low, medium and high risk scores of ASCVD calcuators?

Answer 34

Over a 10-year span, a coronary heart disease risk >20% is considered high risk, 10%–20% is intermediate risk, and <10% is low risk

Question 35

Some differences between men and women with heart disease?

Answer 35

risk for coronary artery disease conferred by cigarette smoking is 25% greater in women than in men. Furthermore, the combination of smoking with oral contraceptive use has a synergistic effect on the risk of acute myocardial infarction, stroke, and venous thromboembolism (SOR A). In addition, fewer women survive their first myocardial infarction compared to men. women were more likely than men to present without chest pain and have higher mortality than men, especially in younger age groups.