CV 4 Flashcards
What are the 4 indications for Statin therapy?
- Clinically significant vascular lesion/ASCVD
- -> Age > 75 - mod dose
- ->Age < 75 - high dose - LDL > 190
- DM ages 40-75 + LDL > 70
- -> ASCVD >7.5% - high dose
- -> ASCVD <7.5% - mod dose - Ages 40-75 + LDL 70-189
- -> ASCVD > 7.5% - mod/high dose
What is the stepwise treatment of Peripheral Artery Disease?
Steps 1A?
Step 1B?
Step 2?
Step 3?
Step 1A: (Risk Factor management)
- ASA
- Statin (high dose if < 75, Mod if >75)
- Smoking Cessation
Step 1A:
- Supervised Exercise therapy (goal = moderate increase in symptom free walking)
Step 2:
- Cilostazole (add to above if above not working)
Step 3: Revascularize
- Stent vs bypass (for persistent symptoms.
What are the two classic HIGH dose Statins?
What is the mod intensity dose?
High dose:
- Atorvastatin 40-80
- Rosuvastatin 20-40
Moderate:
Atorva 10-20
Rosuva 5-10
For “High Cardiac Risk” (Aortic, Major vessel, Peripheral Artery) and “Intermediate” (carotid endardectomy, head/neck, Abd/Thoracic, orthopedic and prostate) surgeries…
What is the general rule to see if they need a cardiac work up prior to surgery?
General Rule - if their functioning status ok (> 4 mets) without problem (i.e. brisk walk or 2 flights of stair), no further cardiac work up is needed.
Torsades de Pointes is due to what?
What are the 4 things that are known to incite Torsades?
Acquired or Congenital prolonged QT
- Hypothermia
- Electrolyte disturbance (hypoK, hypoMg, HypoCa)
- Meds (antipsychotics, antifungals, antidepressants, fluoroquinolones)
- Bradycardia (2nd/3rd AV block)
What is the TRX for Torsades de Pointes?
TRX = IV magnesium
IF not magnesium responsive –> Transcutaneous pacing
Down syndrome is associated with what cardiac abnormality?
DS is also associated with what 4 GI, skeletal, and Endocrine issues?
What cancer is increased in DS?
What 5 neuropsychiatric disorders are associated with DS?
Endocardial cushion defect (ASD, VSD, AV valve malformation)
- Duodenal Atresia
- Hirshprung Disease
- Atlando-axial instability
- Hypothyroidism.
Increase in Leukemia (AML and ALL)
- MDD
- ADHD
- Autism
- Dementia/Alzheimers (3rd/4th decade)
- Seizure d/o
Idiopathic Pulmonary HTN presents with what Physical Exam findings?
CXR shows?
DX?
First line TRX:
- Prominent RV heave
- Loud P2
- Sympt of RH Failure
- +/- pansystolic tricuspid regurg mumur
CXR = Enlargement of Pulmonary Artery
DX = First do Echo, definitive by R heart Cath w pulm A pressure > 25mmHg
TRX: Endothelin Receptor Antagonist
- BOSENTAN
- AMBRISENTAN
In treatment of Pulmonary Hypertension Other than Endothelin Receptor Antagonist, what other classes of medications can you add if you continue to have symptoms?
5- Phosphodiesterase Inhibitors:
- Sildenafil
Prostacylin Pathway Agonist
- Epoprostenol
- Treprostinil
- Iloprost
What are the indication for CABG vs PCI?
CABG:
- Large vessel (LAD) or 3 vessels
PCI:
- 1-2 vessels (NO LAD involvement)
What is cardiac resynchronization therapy for CHF?
What is the indication?
Placement of Biventricular pacing device.
Indication:
1. LVEF < 35% + QRS > 150 msec
OR
2. Symptomatic LVHF + QRS > 150msec
(so basically L heart failure with QRS > 150)
What is the approach to treating Varicose Veins?
What is the indication for Surgical Ligation and stripping?
First:
- 3-6 months of conservative trx (leg elevation, compression stocking)
IF above fails:
- Sclerotherapy
LARGE veins that are bleeding, ulcerated, or with recurrent thrombophlebitis.
What is the most common cause of HTN in ages 0-39?
Renal parenchymal disease.
What are the two dreaded side effects of Statins?
What do you do if you develop these?
MYOSITIS and HEPATITIS…
STOP Statin, then after resolution, restart Statin at LOWER DOSE.
Statins can cause Myositis and Hepatitis…how often should you check LFTs and CPK for patient on Statins?
Routine CPK and LFTS not recommended.
Get them when symptomatic.
