CVD Prevention/ Screening

Question 1

• CVD and depression: Dep assoc. with? (2)
• 2x risk of getting
• Predicts MI death after?
• Rehospitalization? Ind. pred. of? LVEF?
• Possible mechanisms? (2)
• Treatment options? (3)
• Collaborative care benefits?
• SSRI’s and welbutrin: Problem?
• BB and depression?
• Screen how?

Answer 1

• 1st MI and cardiac death
• CAD
• ACS or MI
• More likely; mortality; lower with depression
  1. ) Physiological: Auto dysfunction increases cortisol and plt activation, endo dys and inflamm.; preceived fear leads to stress response from amygdala; defective seratonin signalling
  2. ) Behavioral: Lower PA, adherence, less follow up
• SSRI; cog therapy; collaborative care
• cost effective primary care
• Takes up to 4 weeks to kick in
• Not related
• Mood and anhodenia questions

Question 2

• Lab Findings:

- SOB: BNP

Answer 2

• Sensitive and specific it is not CHF; vent. stretch
• EKG, troponin, CK
• Tr, EKG, Angiography
• A,B (vent.) and C (endothelium)
• Ventricles, stretched; LVEDP, NYHA score, HF in pt’s over 55; women, elderly, renal insufficiency
• RF

Question 3

• Primary Prevention:
• Factors that decrease CV disease?
• Main risk factor for CVD and stroke?
• Myths with CVD? (4)
• 2 possible prevention approaches?
• Side effects of statins? (2)
• Asa works for? (2) Not? (2)

Answer 3

• BP, lipids, smoking
• Htx
• Gycemic control decrease large vessel disease outcomes (does help for microvascular); Asa a day for T2D over 40 helps with CVD; High HDL by drugs helps outcomes; smoke free policy difinitively helps with AMI
• Community programs; policy changes
• Increased HbA1C and cognitive side effects
• CAD/stroke patients; DM or primary prevention

Question 4

• What does 2ndary prevention mean? Goal?
• Guidelines: 1, 2a, 2b, 3
• Evidence: A, B, C
• Anti plt’s/ theino for who? (3)
• BB: 1a for? 2a for?
• RAAS for? (5)
• BP control current reccomendation? (2)
• Cholesterol control based on? not?
• Diabetes is same risk as? Class 1? 2a? 2b?
• Depression: 2a? 2b?
• Smoking cessation?
• Obesity: Class 1? (2)
• PA: Class 1?

Answer 4

• Evidence of disease; prevent rupture/progression
• Should do it; reasonable; maybe; don’t do it
• RCT’s; obs./case; expert opinion
• CAD pts, ACS, PCI
• LVSD 60
• Dose; number
• Prior MI; Lifestyle mod; metformin; HbA1C

Question 5

• How do micro bubbles work with ECHO?
• Stress test shows? (5) Available imaging?
• ETT: Indications? (5) Contra? (9) Test is best for? (2)
• Imaging Stress test: Types? (2) Indications? (5) Contra?
• Perfusion study: Tracer deposited based on? Reversible? Fixed? Thallium 201? Technetium 99?
• MRI: Contra? (2) Anatomic? Functional?

Answer 5

• Can’t pass through pulm capillaries
• Ischemia, changes in BP, ECG, symptoms, flow, wall motion; UA, arrhythmia, CHF, AV block, carditis, ACS, HOCM, Bad Htx, Acute illness; ID left main or 3 vessel disease
• Echo, nuclear; abnormal baseline ECG, better sensitivity; same as ETT
• Blood flow; reversible ischemia; infarction/scar; continuous exchange across membrane; one pass
• Metal; kidney dysfunction for Gadolinium; spin; cine MRI