CV Disease Prevention-Adams

Question 1

At what heart rate or higher would you consider the primary concern to be caused by tachycardia?

Answer 1

150. 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.

Question 2

Age to start trackeing cholesterol for men and women?

Answer 2

35 is men and 45 for women. If at high risk, start at 20

Question 3

Memorize the 8 modifiable risk factors for CVD.

Answer 3

HYPERTENSION

DYSLIPIDEMIA

Chronic inflammaiton

Obesity

CIGARETTES

IMPAIRED GLUCOSE TOLERANCE

Lack of exercise

Booze

Question 4

What are nonmodifiable risk factors for CVD?

Answer 4

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)

Question 5

LDL goals for CHD or CHD Risk equivalents (10 ear risk is greater than 20%)

Answer 5

LDL less than 100

Question 6

LDL goal with 2+ risk factors (10 year risk is less than 20%)

Answer 6

LDL less than 130

Question 7

0-1 risk factors LDL goal?

Answer 7

LDL less than 60

Question 8

Biggest concern for dyslipedemia?

Answer 8

LDL is biggest concern, treat triglycerides and HDL after you get LDL in right direction.

Question 9

Recommendations for dyslipedemia?

Answer 9

Reduce sat fat and cholesterol.

Mediterranean diet is great (fish and legume)

Medication with diets can be used

Question 10

Here is a stat for ya that they might test. How much is cigarette smoking decreased just by a doc advising to quit smoking?

Answer 10

10% helped. Behavior modification and meds increase to 35%

Question 11

What are the 4 As in smoking cessation?

Answer 11

Ask about smoking and habbits

Advise against smoking: role model, pregnancy, wrinkles…

Assist in behavior modyfying tech and meds

Arrange follow up

Question 12

5 stages to quit smoking

Answer 12

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”

Question 13

What are the two drugs to help quit smoking?

Answer 13

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.

Question 14

Fasting glucose levels for impaired glucose tolerance and diabetes?

Answer 14

IGT is 110-125, diabetes is more than 125

Question 15

What is metabolic syndrome?

Answer 15

Insulin resistance, HTN, dyslipidemia, high CRP, obesity

Question 16

How does physical activity help decrease risk of CV disease?

Answer 16

Higher HDL, improve insulin utilization, increases number of insulin receptors. TRY TO GET 30 MINUTES PER DAY.

Question 17

How does booze effect CV system?

Answer 17

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

Question 18

Homocysteine and CV issues?

Answer 18

Associated with higher risk. Supplemental folic acid and B vits may help lower levels, but no benefits with preeisting CV disease.

Question 19

How do you lower levels of homocysteine?

Answer 19

Folic acid and B 12 can help

Question 20

What can C Reactive Protein say for risk of CV disease

Answer 20

It is a marker of inflammation and shows could have future CV disease and increased likelhood of diabetes

Question 21

Does aspirin help in people with no risk?

Answer 21

No benefit of helping low risk patients and tradeoff between benefit and harm

Question 22

Do antioxidants help if people are of no risk of heart disease?

Answer 22

Effectiveness is unknown and it use isnt justified.

Question 23

What two vitamins have been found to be harmful to people in terms of CV disease?

Answer 23

Beta carotene and Vitamin E may incease death.

Question 24

What are CVD risk equivalents? (4 of them)

Answer 24

Noncoronary atherosclerosis

Multiple risk factost (metabolic syndrome)

Diabetes mellitus Type II

Chronic Kidney disease

Question 25

What drugs help if already had ischemic event and at high risk of arrhythmic death?

Answer 25

Amiodarone

Question 26

What drugs are not optional if already had an ischemic event?

Answer 26

ACE inhibitor

Anticoag/antiplatelet

NOT OPTIONAL TO USE THEM

Question 27

What are drug classes for people who had ischemic event?

Answer 27

BP drugs, B blockers, antiplatelts/clotting, ACE inhibior

Question 28

Secondary prevention health habigts?

Answer 28

Eat more fish, mediterranean diet, smoking cessation, stress management, one to 2 drinks per day.

Question 29

What antiplatelet drug is not good for secondary prevention (after event happened)?

Answer 29

GP IIb/IIIa inhibitors (eptifitabide) b/c moe bleeding associated with it. It is only really used when you send to cath lab.

Question 30

Is it a good idea to use antiplatelets and anticoags together?

Answer 30

No evidence of advantage vs increased risk of bleeds. So dont use it

Question 31

Role of Class 1 antiarrhythmic agents after ischemic event?

Answer 31

Dont use them! increased moretality!