chronic CV pt 1 Flashcards
exam findings for hyperlipidemia
skin lesions - eruptive or tendinous xanthomas
lipema retinalis
lipemic blood sample
dyslipidemia screening
all adults >20 years every 5 years
earlier and more often if familial hx
middle-older adults q1-2 years
when to start statin
LDL>100 + CV risk
maybe lower (LDL 55-70) for higher risk
low risk - >130 after lifestyle modification
women risk factor for CAD
PO contraception - d/c with dyslipidemia
statins AEs
myopathy/myosis, elevated LFTs, N/V/D, abd pain, HA, insomnia, rhabdo, hyperglycemia
statin monitoring
baseline LFTs
lipid panel at 6 week intervals
drug interactions
LFTs, CK if myalgias
consider decreasing dose when 2 consecutive LDL<40
statin contraindications
absolute - pregnancy, liver disease
relative - meds (cyclosporins, macrolides, antifungals, CYP 450 inhibitors)
ezetemibe indication, monitoring, CI
LDL reduction in statin-intolerant individuals or combo therapy
baseline LFTs
CI in hepatic impairment
bile acid sequesterants considerations & AE & CI
drug/drug interactions, vitamin malabsorption
may increase triglycerides, CI in TG>300
CONSTIPATION, dyspepsia, bloating, cramping, abd distention –>decrease adherence
CI in TG>300
hypertriglyceride treatment
TG>300
fibrates
niacin
fibrates AE, considerations, & CI
GI - abd bloating, N/V/D, gallstones
drug interactions ,monitor LFTs, monitor renal function
CI in renal & hepatic disease
niacin AE & monitoring & CI
flushing with itching
take ASA 30 mins before, take at night
monitor LFTs
CI - liver disease, severe gout
PCSK9 inhibitors
combo therapy w statin to lower LDL in those w family history
SQ injection
omega 3 fatty acid - icosapent ethyl
for marked hypertriglyceridemia
can increase LDL & prolong bleeding
serious risk in pregnancy
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CHD/CAD exam findings
S4
S3 - ventric dysfunction
obesity
leg edema
pulmonary congestion
diagonal ear crease
hair patterns
lab findings for CHD/CAD
ACS - troponin
lipid panel
elevated ESR/CRP
elevated homocystine
CHD/CAD diagnostics
coronary angiography - diagnostic
myocardial stress test - initially performed
EKG - normal
CHD/CAD managment
decrease risk!!!!
secondary - for secondary CAD with intermittent CP
antiplatelets, beta blockers - after MI or ACS, ACE/ARB
PCI revascularization
cardiomyopathy
cardiac muscle dysfunction that results in systolic or diastolic dysfunction that is not due to atherosclerosis, HTN, or valvular disease
dilated cardiomyopathy
-ventricular enlargement
-contractile dysfunction
-normal LV wall thickness
- systolic and diastolic dysfunction
most idiopathic
dilated cardiomyopathy s/s
s/s of gradual heart failure
heart failure exam findings
tachypnea
tachycardia
HTN
hypoxia
JVD
pulm edema
S3
murmur
hepatomegaly
peripheral edema
heart failure symptoms
fatigue
DOE
dyspnea
orthopnea
PND
increasing edema, weight gain, increasing abdominal girth
dilated cardiomyopathy diagnostics
labs - anemia, hyponatremia, low bicarb, TSH, biomarkers, BNP
EKG -baseline
CXR - cardiomegaly, pulm congestion
ECHO - LV dilation
cardiac cath
dilated cardiomyopathy mgmt
same as for CHF
treat underlying conditions/RF
Na & water restriction
meds - decrease BP, antiarrhythmics, anticoagulation
pacer, AICD, LVAD, transplant
meds for dilated cardiomyopathy
ACE/ARB
diuretics - loop
avoid CCB
antiarrhythmics - dig
hydral - decrease preload
anticoagulation for A fib
hypertrophic cardiomyopathy
increased LV thickness
stiff LV restricts ventricular filling
diastolic HF
hypertrophic cardiomyopathy cause
genetic
top symptoms for hypertrophic cardiomyopathy
dyspnea!
pre-syncope
syncope
angina
sudden cardiac death if severe
dilated cardiomyopathy exam findings
double/triple apical pulse
s4
murmur - positional
bisferiens carotid pulse
hypertrophic cardiomyopathy diagnosis
TTE
restrictive cardiomyopathy mgmt
no specific tx
treat underlying cause & symptoms
hypertrophic cardiomyopathy diagnosis
TTE
restrictive cardiomyopathy
impaired diastolic filling
reasonably preserved contractility
diastolic HF
amyloidosis/sarcoidosis #1 cause
restrictive cardiomyopathy symptoms
gradually worsening SOB
progressive exercise intolerance
fatigue
weakness
hypertrophic cardiomyopathy mgmt
cards referral, pregnancy/genetic counseling
goal to decrease cardiac contractility! no more exercising
BETABLOCKERS (metop), calcium channel blockers
ICD/pacer -RV, transplant, ablation, myomectomy
restrictive cardiomyopathy differential
constrictive pericarditis
check BNP
restrictive cardiomyopathy exam findings
RH failure
JVD
ascites
hepatomegaly
murmurs
decreased pulse volume
healthy total cholesterol
<200
