CV Disease Prevention-Adams Flashcards
At what heart rate or higher would you consider the primary concern to be caused by tachycardia?
- If lower, it is still tachycardia but likely a response to another health issue, so look for what is causing it, rather than just throughin on dilitiazam.
Age to start trackeing cholesterol for men and women?
35 is men and 45 for women. If at high risk, start at 20
Memorize the 8 modifiable risk factors for CVD.
HYPERTENSION
DYSLIPIDEMIA
Chronic inflammaiton
Obesity
CIGARETTES
IMPAIRED GLUCOSE TOLERANCE
Lack of exercise
Booze
What are nonmodifiable risk factors for CVD?
Age: M is 45, W is 55 (or premature menopause)
FH: dad younger than 55 or mom younger 65
Hypertension (systolic more concerning, notice can be considered modifiable too)
LDL goals for CHD or CHD Risk equivalents (10 ear risk is greater than 20%)
LDL less than 100
LDL goal with 2+ risk factors (10 year risk is less than 20%)
LDL less than 130
0-1 risk factors LDL goal?
LDL less than 60
Biggest concern for dyslipedemia?
LDL is biggest concern, treat triglycerides and HDL after you get LDL in right direction.
Recommendations for dyslipedemia?
Reduce sat fat and cholesterol.
Mediterranean diet is great (fish and legume)
Medication with diets can be used
Here is a stat for ya that they might test. How much is cigarette smoking decreased just by a doc advising to quit smoking?
10% helped. Behavior modification and meds increase to 35%
What are the 4 As in smoking cessation?
Ask about smoking and habbits
Advise against smoking: role model, pregnancy, wrinkles…
Assist in behavior modyfying tech and meds
Arrange follow up
5 stages to quit smoking
precontemplation: “its not a problem”
contemplation: “meh, its bad. still not quitting”
Prepraation: “want to quit, lets do it”
Action: “IM DOING IT!”
Maintaenance: “IM STILL DOING IT NO RELAPSE”
What are the two drugs to help quit smoking?
Verenicline (chantix) is a nicotinic receptor competitive agonist. Tad better than bupropion.
Bupropion inhibits uptake of NE, sertonin and dopamine and might reduce urge to smoke.
Fasting glucose levels for impaired glucose tolerance and diabetes?
IGT is 110-125, diabetes is more than 125
What is metabolic syndrome?
Insulin resistance, HTN, dyslipidemia, high CRP, obesity
How does physical activity help decrease risk of CV disease?
Higher HDL, improve insulin utilization, increases number of insulin receptors. TRY TO GET 30 MINUTES PER DAY.
How does booze effect CV system?
2 drink or less can benefit and increase HDL. Higher amounts can cause direct cardiomyopathy, a fib, hypertension and high calories can lead to obesity
Homocysteine and CV issues?
Associated with higher risk. Supplemental folic acid and B vits may help lower levels, but no benefits with preeisting CV disease.
How do you lower levels of homocysteine?
Folic acid and B 12 can help
What can C Reactive Protein say for risk of CV disease
It is a marker of inflammation and shows could have future CV disease and increased likelhood of diabetes
Does aspirin help in people with no risk?
No benefit of helping low risk patients and tradeoff between benefit and harm
Do antioxidants help if people are of no risk of heart disease?
Effectiveness is unknown and it use isnt justified.
What two vitamins have been found to be harmful to people in terms of CV disease?
Beta carotene and Vitamin E may incease death.
What are CVD risk equivalents? (4 of them)
Noncoronary atherosclerosis
Multiple risk factost (metabolic syndrome)
Diabetes mellitus Type II
Chronic Kidney disease
What drugs help if already had ischemic event and at high risk of arrhythmic death?
Amiodarone
What drugs are not optional if already had an ischemic event?
ACE inhibitor
Anticoag/antiplatelet
NOT OPTIONAL TO USE THEM
What are drug classes for people who had ischemic event?
BP drugs, B blockers, antiplatelts/clotting, ACE inhibior
Secondary prevention health habigts?
Eat more fish, mediterranean diet, smoking cessation, stress management, one to 2 drinks per day.
What antiplatelet drug is not good for secondary prevention (after event happened)?
GP IIb/IIIa inhibitors (eptifitabide) b/c moe bleeding associated with it. It is only really used when you send to cath lab.
Is it a good idea to use antiplatelets and anticoags together?
No evidence of advantage vs increased risk of bleeds. So dont use it
Role of Class 1 antiarrhythmic agents after ischemic event?
Dont use them! increased moretality!
