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CV diseases Flashcards

1
Q

stages of bp

A

Normal: <120/<80
Elevated: 120-129/<80
HTN Stage 1: 130-139 or 80-89
HTN Stage 2: 140 + or 90+
HTN Urgency: >180/120 no signs of end- organ dysfunction (prompt referral)
Emergency (urgency plus end organ dysfunction)

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2
Q

define htn

A

A PATHOLOGIC DYSREGULATION OF THE HOMEOSTATIC MECHANISMS THAT CONTROL BLOOD PRESSURE
can be essential or secondary
essential - no cause?
secondary is from a disease process that also causes htn

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3
Q

medications treat htn

A

Ca2+ channel blockers, Ace inhibitors, Angiotensin receptor blockers, Beta Blockers, Thiazide diuretics, direct renin inhibitors, Alpha-2 agonists
(need to know how these work)

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4
Q

how does HTN effect surgery/sedation:

A
  • Defer elective surgery if not controlled
  • Continue anti-HTN medications (especially B Blockers) except for ACE inhibitors/arbs and
    diuretics
  • Consider pre-op labs (BMP, EKG) to look at kidney function (BUN/Cr) and potassium levels
  • Intra-op BP within 20% of baseline
  • Avoid Ketamine (sympathomimetic)
  • Activate emergency system (911 vs Code Blue) for BP >180/120 with s/s of end organ dysfunction (MI, dyspnea, AMS, seizures, etc.)
  • For HTN crisis, slowly reduce BP, too fast can lead to MI and cerebrovascular ischemia
  • continue taking htn medications EXCEPT ARBs and ACE inh because this can cause refractory hypotension via anesthetic medications
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5
Q

angina

A

Reversible hypoperfusion of coronary artery system leading to chest pain

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6
Q

stable angina

A

reversible hypo perfusion of the Coronary artery system, Symptoms with exertion, relieved with rest (5-10 mins), indication that vessels are 70% + stenotic

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7
Q

unstable angina

A

symptoms with exertion and not relieved by rest, or chest pain at rest

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8
Q

STEMI

A

MI with st segment elevation, you see this in an occlusive thrombus, transmural infarct

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9
Q

NSTEMI

A

MI without st segment elevation
can see t wave inversion or st segment depression
due to partially occlusive thrombus, that results in subendocardial infarct.

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10
Q

Ischemic cardiac disease soundbite

A

in the cardiac tissue there is not enough oxygen for the demand needed. often secondary to stenotic and occluded coronary arteries.

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11
Q

MI soundbite

A

Infarct of myocardium secondary to hypoperfusion

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12
Q

how does stent effect your surgery?

A

non cardiac surgery can be carried out 6 weeks after stent
non emergent surgery should wait 6 mo regardless of stent type
keep on asa and clopidogrel if possible
give anxiolytics, profound local with cardiac restriction (40mcg, 2 carps?)
EKG
BP and HR 20% of baseline

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13
Q

how to calculate cardiac risk if symptoms of Acute Coronary Syndrome (ie chest pain

A

HEART score for major cardiac events
points for:
1) suspicious history
2) EKG changes concerning
3) age less than 45, 45-64, 65 plus
4) risk factors: THN, hypercholesterolemia, dm, obesity BMI greater than 30, smoking or smoking within 3 mo, positive family history, prior MI, PCI, cab, cv/tia, peripheral artery disease
5) troponin

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14
Q

rcri for and components

A

rcri revised cardiac risk index - 30 day risk of death, MI, cardiac arrest
1) elective surgery
2) hx of ischemic heart disease
3) CHF
4) strok/tia
5) pre-op tx with insulin
6) pre-op creatinine greater than 2 mg/dL

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15
Q

CHF soundbite

A

is THE HEART fails TO PUMP ENOUGH BLOOD TO MEET THE METABOLIC DEMANDS OF THE TISSUES
types:
preserved ejection fraction (diastolic) ef greater than 50% - issues with filling often secondary to wall thickness
reduced ejection fraction (systolic hf) - ef reduced less than 40%. often impaired contractility

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16
Q

CHF classification system

A

New York heart association classification - classified on physical activity limitation
-Class 1: Heart disease with no symptoms or
limitations of physical activity
- Class 2: No symp at rest, slight limitations with ordinary activity
- Class 3: Marked limitation of activity with minimal exertion
- Class 4: Symptoms at rest. Severe limitation of activity

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17
Q

s/s of CHF and workup and tx

A

edema, dvd, hepatomegaly, s3/s4
order ekg, echo, car, labs
bnp (35 pg/mL, 100 pg/mL) (non acute and acute)
and
diuretics, beta blockers

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18
Q

Cardiomyopathy soundbite and diagnostic test

A

is a disease process affecting the myocardium that impairs the heart’s ability to pump or fill
diagnostic test is echocardiogram
also can get CHF in cardiomyopathy

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19
Q

types of cardiomyopathy

A
  • Hypertrophic Cardiomyopathy (non-obstructive type): MCC is HTN,
    thickened walls, reduced space for blood
    ¡ Hypertrophic Obstructive Cardiomyopathy: Similar to above but with obstruction of outflow by interventricular septum blocking blood flowing out of the aorta. Genetic (AD). Common cause of young athletes dying
    ¡ Dilated Cardiomyopathy: Opposite from above, can FILL but can cannot pump, MCCs are MI, alcoholism
    ¡ Restrictive Cardiomyopathy: A little different, problems with filling and pumping, Rigidity of the myocardium, have histologic damage, infiltration, MCC is sarcoidosis, also can be amyloidosis, hemochromatosis, scleroderma, malignancy often from mets
20
Q

atrial fibrillation soundbite

A

Abnormal electric foci in the atrium leading to irregularly irregular rhythm (as only some electricity gets to AV node) kk addition parenthesis

21
Q

virchows triad, vte risk

A

endothelial damage, stasis of flow, hyper coagulable state

22
Q

what used to predict stroke in fib

A

cha2ds2vasc
CHF
htn
age greater than 65, and greater than 75
Diabetes
stroke
vascular disease
female

23
Q

predict bleeding risk for people on aticoag in atrial fibrillation

A

HASBLED

24
Q

Cardiac Transplant considerations with surgery

A
  • full medical with their transplant team
    Heavily immunosuppressed
    ¡ Resting HR of 90-100
    ¡ Transplanted heart is denervated, no symp/parasymp inputs, DOES NOT respond to indirect-acting meds (neostigmine, glycol, atropine)
    ¡ Ephedrine is decreased
    ¡ Norepi, Epi, B Blockers work
    ¡ Residual atrial tissue from the original heart, uncommon but does happen, can cause a double P wave on EKG
25
Q

secondary htn can be caused by

A

pheochromocytoma
renal artery stenosis
polycythemia vera
cushings syndrome
coarctation of the aorta
hyperaldosteronism
pregnancy
renal parenchymal disease

26
Q

poorly controlled htn can cause

A

remember can be associated:
L ventricular hypertrophy
ischemic heart disease
chf
renal insufficiency
retinopathy/vision loss
tia/stroke
PVD

27
Q

amlodipine, felodipine, diltiazem, verapamil are examples of htn, cad

A

ca channel blockers - vasodilation by decreasing calcium ion influx
decrease oxygen demand by decreasing heart rate and contractility (only some of the above…)

28
Q

-pril (lisinopril, fosinopril, knalapril, captopril, ramipril)

A

ace inhibitors -
block the conversion of angiotensin 1 to 2 which inhibits vasoconstriction and decreases aldosterone effects which decreases blood pressure
CAD - the decreased vasoconstriction decreases the after load and helps prevent aberrant cardiac remodeling

29
Q
  • sartan
    losartan, valsartan, olmesartan, telmisartan
A

Angiotensin II receptor blockers (ARBs)
block the effects of angiotensin II which inhibits vasoconstriction and decreases aldosterone effect like ace inhibitors

30
Q

-lol, metoprolol, atenolol, esmolol, carvedilol, labetalol and effect of local? htn, cad

A

beta blockers
block beta adrenergic receptors - decreasing myocardial contractility and rate, decrease renin production, relaxation of smooth muscles
CAD - decrease oxygen demand by decreasing heart rate and contractility
amide anesthetics metabolism can be reduced in people taking beta blockers

31
Q

hydrochlorothiazide and chlorthalidone

A

thiazide diuretics
block reabsorption of NaCl in the nephron decreasing intravascular volume

32
Q

intraoperative hypotension treat with

A

ephedrine or phenylephrine, phenylephrine can cause reflex bradicardia

33
Q

ace inh and arbs - with sedation consideration

A

intraoperative refractory hypotension and
check bmp to rule out hypokalemia

34
Q

atherosclerosis soundbite and pathophys ACS

A

hardening of the arteries due to lipid accumulation within the arterial wall
lipids get in via endothelial damage, if the fibrous cap ruptures there is a thrombotic lipid core and can cause ACS/infarction of that tissue

35
Q

dyslipidemia and contributing factors to CAD

A

total cholesterol of greater than 240 mg/dl
elevated ldl
(and elevated hdl) - protective against atherosclerosis
-tobacco - enhances oxidation of ldl, endothelial dysfunction, increased platelet adhesiveness
-htn - damages endothelium - increases permeability of lipoproteins
-diabetes - glycosylation of ldls to increase their effect
-lack of physical activity
-estrogen protective, postmenopausal women increase risk

36
Q

workup for angina

A

stress test,
pharmacologic testing with dipyridamole thallium when unable to exercise,
echocardiogram (wall fin, EF, valvular function), and
coronary angiography for stenotic coronary arteries (which is the gold standard)

37
Q

isosorbide mononitrate or nitroglycerin

A

nitrates -
ventilation, decrease preload and dilates coronary arteries

38
Q

ranolazine

A

inhibits sodium channels in myocardial cells which leads to less contractility

39
Q

which drugs increase the amount of time the heart spends in diastole?

A

calcium channel blockers and beta blockers
important with CAD people because this is when coronary perfusion occurs - in diastole, makes sense

40
Q

clopidogrel, prasurgel, ticagrelor

A

adp receptor inhibitors
decrease add activation of platelet aggregation to prevent coronary thrombosis

41
Q

-statin, atorvastatin, simvastatin

A

hmm coa reductase inhibitors that decrease circulating LDL levels, decreasing atherosclerosis

42
Q

mets and when to consider cardiac testing/hospital

A

strenuous/jumping rope - greater than 10 METS
7-10 - jogging/calisthenics
4-6 - power walking, sex, leisure biking
less than 4 mets, consider cardiac testing/hospital setting

43
Q

surgical mgmt of CHF patient

A

positioning,
oxygen
BMP - hypokalemia because of diuretics, etc
Avoid NSAIDs - puts at risk for renal failure
careful with fluids
tx in hospital setting

44
Q

types of acute coronary syndrome

A

check: per Andrew OSFC
Angina (unstable?) - will likely clinically be reversible with rest or nitro and NEGATIVE for troponins. could potentially see ST depression??
NSTEMI - positive for trops, could see st depression or inverted T waves- and is an endocardial infarct
STEMI - positive for troponins, st elevation and is a transmural infarct

45
Q

if you have a transplanted heart what medications will work and what medications won’t work?

A

only medications that work directly on the heart WILL work: Epi, beta blockers an glucagon? (per nick OSFC)
for example indirect will not work - like phenylephrine

46
Q

s3 heart sound

A

look up

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