Heart health Flashcards

1
Q

What is ASCVD?

A

Peripheral artery dz (PAD)
Cerebrovascular dz
Coronary heart dx (CHD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is greatest cause of morbidity and mortality in DM?

A

ASCVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for ASCVD?

A
Overweight/obesity
Smoking
HTN
HLD
CKD
albuminuria
Family hx premature coronary dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the ASCVD risk calculator?

A

10 year risk of 1st CV event
age 40-79
DM is a risk however doesn’t ask about duration or complications from DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

HF hospitalization is how much higher in PWD?

A

2x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why should we do HTN tx?

A

Reduces HF, microvascular complications, ASCVD events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How should HTN be dx?

A

at every routine visit

3 abnormal values on separate occasions to dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment of HTN to what BP reduces CV events &microvascular complications?

A

<140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why should PWD monitor BP at home?

A

White coat syndrome
masked HTN
DTR effectiveness of meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are HTN goals in adults w/ DM?

A

<140/90 if low CV risk (ASCVD risk <15%) OR if adverse effects to intensive tx
<130/90 if existing ASCVD or 10 year risk >/=15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

BP goal in pregnant women w/ HTN

A

135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk of overtreating HTN?

A

hypotension
falls
acute kidney injury
electrolyte abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who is at risk for overtreatment of HTN

A
CKD
orthostatic HTN
functional limitations
significant comorbidities
polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to treat HTN in pregnancy?

A

Do NOT use- spironolactone, ARB, ACE
Can use- labetolol, methyldopa, long acting nifedipine
May use hydralazine w/ preeclampsia
Diuretic only in late pregnancy for volume control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to monitor BP after birth?

A

3 days in hospital
7-10 days PP
LT follow-up recommended s/t lifelong increased risk of CV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DASH diet

A

2,300 mg sodium/day
2-3 svgs LF dairy
8-10 svgs F/V combined
avoid excessive etoh

17
Q

How to treat HTN if BP >140/90 but <160/100 AND w/o elevated UACR

A

1 med to start

ACE, ARB, CCB, or Thiazide like diuretic can be used

18
Q

IF HTN + elevated UACR >30 but definitely >300

A

ACE or ARB

19
Q

What if BP is >160/100

A

2 meds

Do NOT combine ARB + ACE

20
Q

What to monitor if on ACE, ARB, or diuretic?

A

EGFR, serum K+, serum creatinine at least annually

21
Q

Why should at least one HTN drug be given at night?

A

Reduces CV events

22
Q

Why should ACE not be given with ARB?

A

Can cause hyperkalemia and/or AKI, which can increase risk of CV event/death

23
Q

What is resistant HTN?

How to treat it?

A

On 3 classes of HTN meds including diuretic and still not meeting goals
Confirm that pt is taking meds as directed
Start mineralcorticoid, which can reduce albuminuria but may increase hyperkalemia risk

24
Q

How does glycemic control effect lipids?

A

Poor glycemic control can raise TG

25
If a PWD is <40 years old, not on a statin, when should lipids be taken?
At dx, initial medical evaluation, q 5 years if <40
26
If pt is on a statin, when should lipid panel be taken?
@ initiation of statin or other lipid lowering medication 4-12 weeks after starting statin or changing dose annually after
27
What do do w/ pt 40-75 w/o ASCVD for primary prevention
moderate intensity statin
28
What if pt is <40 but has ASCVD risk factors for primary prevention
may consider statin+lifestyle changes
29
In pts at higher risk (ASCVD risk factors, age 50-70) for primary prevention
use high intensity statin
30
if 10 year ASCVD risk is >20%, what can be added to reduce LDL by 50%
ezetimibe
31
what should all PWD w/ confirmed ASCVD get
high dose statin
32
If LDL >70 and on maximally tolerated statin w/ confirmed ASCVD
ezetimibe or PCSK9 inhibitor
33
Can you use a statin during pregnancy?
No
34
How much does a high intensity statin lower LDL compared to moderate?
50% versus 30-49%
35
What are the high dose statins?
Rosuvastatin | Atorvastatin
36
What can PCSK9 do?
Lower LDL 35-60%
37
IMPROVE IT trial
Ezetimibe for pts on statin w/ recent acute coronary syndrome reduced absolute risk 5%, relative risk 14% for major adverse CV events
38
What can be given to pts who need TG lowering but LDL is normal?
Icosapent ethyl | TG 175-499
39
what HLD pattern is most common in DM?
High TG, low HDL