CV 3 Flashcards
What 5 drugs are known to increase Warfarin effect and increase INR?
- Metronidazole
- “quinolones”
- “Azoles”
- Amiodarone ***
- Acetaminophen
What 4 drugs are known to decrease Warfarin effect and Decrease INR?
- St. Johns wart
- Phenytoin
- Rifampin
- OCP.
When starting AMIODARONE on a patient on Warfarin, how should you adjust?
decrease Warfarin dose by 25-50%, bc Amiodarone increases Warfarin’s effect.
What percentage of the population is affected by Bicuspid valve?
More males or females?
Bicuspid valve is associated with what syndrome?
IF it is genetically inherited, what is the pattern?
1%
M>F
Turners Syndrome
Autosomal Dominant with incomplete penetrance
If a patient is diagnosed with Bicuspid Aortic Valve.. do you have to screen the family?
YES, with echo ALL 1st degree relatives.
- How do you manage asymptomatic Bicuspid Aortic Valve?
- When should you consider Balloon Valvuloplasty?
- When should you get AV replacement?
- Echocardiogram q 1-2 years.
- VALVULOPLASY IF:
- Symptoms + meets Criteria for valvuloplasty (AS present, No regurg, no Calcification, Peak Gradient > 50mmHg)
( OR )
- Asymptomatic and want to get pregnant or play sports. - AV Replacement IF:
- Severe symptoms of AS
- Aortic Regurg present OR LV dysfunction present.
What is the mainstay of treatment of Acutely Decompensated Heart failure?
Oxygenate
Lasix (decrease preload)
Hyponatremia in CHF patients, usually parallels severity of HF…it is due to decreased renal perfusion which increased thirst and increases ADH action…both contributing to hyponatrmia.
Correction of Na does not affect clinical outcomes, so you should only correct Na in what two situations?
What is the TRX?
- symptomatic
- Na < 120
TRX = Water restriction
A patient comes into the ED and is found to have to have a STEMI on EKG….
What are the 6 treatments you want to implement?
- Oxygen (for Spo2 < 90)
- NTG (for pain control)
- Dual antiplatelet (ASA 325 and Clopidogrel load)
- Anticoagulate - Heparin
- Beta Blocker (C/I in overt HF, bradycardia or cardiogenic shock)
- High dose Statin asap
- PCI < 90 min
Anomalous Coronary is a common cause of what?
Symptoms?
Sudden cardiac death…think of this on the ddx if sudden cardiac death with no Echo finding suggesting HOCM.
Exertional CP and syncope (exactly like HOCM)
Vasovagal Syncope dx is clinical but can use this test to verify dx?
What is the TRX?
Tilt-Table test.
TRX:
- Reassurance/avoid triggers
- Counter-pressure technique (hand grip, cross legs, arm tensing)
All patient with Heart Failure should be treated with medication regardless of symptoms.
ACEI or ARB
All patients with Heart Failure are placed on ACEI/ARB…
What are the next 4 drugs/interventions to consider in step up therapy? What are their indications?
You initiate above treatment…what are the next 4 drugs/managements in step up therapy?
1) Diuretics (when there is sight limitation of activity)
2) BB (IF EF<40% , once euvolemic)
3) SPIRONOLACTONE (IF EF < 30%, with stable Renal function and K)
- Defibrillator (IF EF < 30%, prevents sudden cardiac death)
- ————————————————————— - ISDN/Hydralazine (if BLACK and EF<40%)
- DIGOXIN (if symptomatic on Spironolactone)
- CARDIAC RESYNCHRONIZATION THERAPY(QRS >150)
- TRANSPLANT/LVAD (If symptoms at rest and above fail)
What is the universal LDL threshold to start High dose statin.
What are the indications for Statin TRX in DM? When do you do Mod vs High dose?
What is the indication for Statin TRX in NON-DM? When do you do Mod/High dose?
LDL> 190 –> start HIGH dose statin
DM: Ages 40-75 yo + LDL >70
- ASCVD risk >7.5 % = High dose statin
- ASCVD risk <7.5 % = Mod dose statin
NON DM: Ages 40-75 + LDL 70-189
-ASCVD risk >7.5 % = Mod to High dose statin.
What is the Statin recommendation for patients with Clinically Significant ASCVD?
(ACS, stable angine, hx of CABG, stroke, tia, PAD, ext)
Age <75 –> High dose statin
Age > 75 –> Mod dose statin
