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RCE Guidelines Studying > Laflamme- Chapter 9 (Miscellaneous) > Flashcards

Laflamme- Chapter 9 (Miscellaneous) Flashcards

1
Q

What are the 6 components of the RCRI?

A 
CAD 
CHF 
CVD 
IDDM 
Cr > 176
Intrathoracic, intraperitoneal or vascular surgery
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2
Q

What is high risk on RCRI?

A

3 or more points = high risk (9%)

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3
Q

What % of troponin elevation is Type 1 MI post surgery?

A

5%

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4
Q

How to reprogram pacemakers during OR? ICD?

A
  • PPM: VOO or DOO

- ICD: Deactivate tachyarrhythmia therapies or magnet during the operation

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5
Q

What % of all CAD deaths can be attributed to smoking?

A

30%

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6
Q

What is benefit of CV reduction after smoking cessation?

A

Similar to non smokers after 5 years of smoking cessation

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7
Q

What do lipoproteins do?

A

-transport TG and cholesterol in the blood

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8
Q

What are chylomicrons?

A

Large nonatherogenic lipoproteins transporting TG from the GI tract

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9
Q

What is VLDL?

A

Large nonatherogenic lipoproteins transporting TG from the liver (apo B100)

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10
Q

What is LDL?

A

Atherogenic lipoproteins responsible for atherosclerosis, mainly contain cholesterol, apoB100

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11
Q

How is LDL calculated?

A

Total cholesterol - HDL - (0.45 x TG)

*only if TG < 4.5 mmol/L

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12
Q

What is HDL?

A

Antitherogenic properties, contains apolipoprotein AoA1

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13
Q

How does hypertriglyceridemia result in more LDL?

A

TG enriched LDL -> Formation of smaller and denser LDL due to modification by hepatic lipase -> dense, atherogenic LDL

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14
Q

What are 12 populations to screen for dyslipidemia?

A

Male > 40

Female > 50

DM

HTN

Smoking

BMI > 27

CrCL < 60

Atherosclerosis

ED

Family history of premature CAD or dyslipidemia

ED

HIV

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15
Q

What are 8 causes of decreased HDL?

A

Smoking

Obesity

Sedentary lifestyle

DM

CRF

HyperTG

Steroids

Cyclosporine

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16
Q

What is inheritance of FH?

A

-LDL R receptor mutation, AD, 1/1000

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17
Q

3 physical exam findings of FH?

A

Xanthelasmas

Senile arcus

Tendinous xanthomas

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18
Q

What is familial dysbetalipoproteinemia?

A

-Homozygote for ApoE2 (less effective binding to hepatic receptors)

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19
Q

Two physical exam findings of Familial Dysbetalipoproteinemia?

A

-Tuberous xanthomas, Palmar xanthomas

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20
Q

Biochemical evidence of Dysbetalipoproteinemia?

A

ApoB/TC ratio < 0.15

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21
Q

Three inherited causes of decreased HDL?

A
  • Apo A1 deficiency
  • Tangiers Disease
  • Familial LCAT deficiency
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22
Q

What to consider Familial combined hyperlipidemia?

A
  • Apo B > 120 mg/dl
  • TG > 1.5 mmol/l
  • History of premature CAD
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23
Q

when to start fenofibrate for hypertriglyceridemia? (2)

A
  • TG > 10

- Pancreatitis

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24
Q

How do statins work?

A
  • HMG Coa reductase inhibitor which reduces the intracellular cholesterol synthesis and increased expression of LDL receptor
  • Pleotropic and antinflammatory response
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25
Q

Name two Bile acid sequestrants and how much do they lower LDL by

A

-Colestipol or Colesevalam, reduced LDL by 15-30%

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26
Q

How does Ezetimibe work and how much does it reduce LDL by?

A
  • 20%

- Interferes with NPC1-L1 protein of intestinal epithelial cells

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27
Q

Only lipid lowering therapy that increased HDL?

A

-Niacin

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28
Q

What are 4 sideeffects of Niacin?

A

-Flushing, Hyperuricemia, Hyperglycemia, Gastritis

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29
Q

What are 7 causes for statin intolerance/myalgias?

A

Hypothyroidism

Renal failure

Liver disease

PMR

Steroid use

Vitamin D deficiency

Primary muscle disease

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30
Q

What 7 risk factors for statin myopathy?

A
  • statin dose
  • drug interactions
  • > 75 years old
  • Renal failure
  • Liver disease
  • Alcohol use
  • Pre-existing myopathy
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31
Q

When should you be worried about statin s/e based on AST/ALT and CK?

A

3x, 5x

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32
Q

How to approach statin toxicity (ALT/AST + CK)

A

-DC statin, consider DDx, monitor until normalization, reintroduce at a lower dose of less potent statin (Pravastatin, Fluvastatin) or QoD dosing

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33
Q

What if statin s/e doesn’t meet criteria to DC based on AST/ALT or CK?

A

-Continue treatment and check again in 6 weeks. If stable than resume.

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34
Q

Three ways to diagnose HTN in the office?

A
  • 180/110 mmhg x 1
  • 160/100 mmhg x 3
  • 140/90 mmhg x 5
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35
Q

ABPM cut offs for HTN diagnosis?

A
  • Daytime > 135/85
  • 24 hour SBP > 130/80
  • Night time BP should drop by 10%
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36
Q

Home BP monitoring cut off?

A

> 135/85

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37
Q

Work up for renovascular disease?

A

-Doppler renal arteries, MRA, CTA

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38
Q

Work up for Primary hyperaldo?

A
  • Increased plasma aldoserone/renin ratio
  • Suppression test with salt load
  • Adrenal CT scan or MRI
  • Adrenal vein catheterization
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39
Q

Work up for Cushings?

A
  • Urinary cortisol
  • Suppression test (1mg dexamethasone)
  • CT scan adrenals
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40
Q

Work up for Pheochromocytoma?

A

-Plasma metanephrines, urine meta, CT scan or MRI

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41
Q

Why might elderly patients have NIBP lower than arterial monitoring?

A

-Secondary to rigid arteries that are not compressed by the cuff

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42
Q

How does Metformin work? How much does it reduce Hba1c by?

A
  • decreases hepatic glucose synthesis

- decrease by 0.8%

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43
Q

Sulfonylureas?

A
  • Stimulates insulin secretion by the pancreas

- 0.7%

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44
Q

GLP1 agonist

A
  • Increase insulin secretion, decreases glucagon secretion

- 1%

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45
Q

DPP4 inhibitors

A

Inhibits the breakdown of GLP1

-0.6%

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46
Q

SGLT2 inhibitor

A

-Decrease glucose reabsorption by the renal proximal tubule

47
Q

4 classes of diabetes meds that have CV benefit?

A
  • Metformin: Benefit on the risk of MI and mortality in obese patients (UKPDS)
  • Sulfonylureas: as above
  • Liraglutide: LEADER trial
  • SGLT2 inhibitor: Empa
48
Q

Name a two diabetes medications that carry CV harm?

A
  • TZDs (HF)

- Saxaglipitin (HF)

49
Q

What is the affect of exercise aerobic exercise on HTN, DSL, Obesity, DM?

A

HTN: 3/2mmhg

DSL: HDL up by 0.06, decrease TG

Obesity: decrease 7kg

Diabetes: Hba1c 0.8%

50
Q

What two CV disease populations have mortality benefit from exercise?

A
  • LVEF < 35% (HF action)

- CAD

51
Q

What is class 1 and 2 obesity?

A

1) BMI 30-35

2) BMI 35-40

52
Q

6 CV benefits of weight loss?

A
  • decreased BP
  • Improved lipid profile
  • DM
  • OSA
  • Inflammatory state
  • Improves endothelial function
53
Q

Waist circumference targets?

A

102 cm < M, 88 cm < F

54
Q

what should weight loss target be over 3-6 months?

A

5%

55
Q

When should drug treatment be started for obesity?

A

-Failure of non drug therapy for 6 months with BMI > 30 or >27

56
Q

When should bariatric surgery be considered?

A

-Class III obesity or Class II with comorbidities

57
Q

What three diets supported by evidence?

A

DASH diet

Mediterranean diet

AHA diet

58
Q

What is definition of OSA?

A

Absence of airflow for >10 seconds despite active ventilatory efforts

59
Q

What is severe AHI?

A

Severe AHI > 30

60
Q

Driving restriction post STEMI?

A

1 month Private vehicle

3 month commercial vehicle

61
Q

Driving- NSTEMI?

A

Depends on WMA. If WMA, same as STEMI

If no WMA:

  • Private: 48h post PCI, 7 days if PCI
  • Commercial: 7 days post PCI, 30 days if no PCI
62
Q

Driving- Elective PCI

A

Private: 48h post PCI

Commercial: 7 days post PCI

63
Q

Driving- CABG

A

Same as STEMI

64
Q

LMCA disease

A

No private driving if > 70%

No commercial driving if > 50%

65
Q

Driving- VF/VT?

A

No reversible cause:

Private: 6 months

Commercial: Never

66
Q

Stable Sustained VT if LVEF > 30%? If < 30%

A

Private: 4 weeks, 3 months

Commercial: 3 months, never

67
Q

Driving restriction if Symptomatic SSS, Mobitz II, CHB, Alternating LBBB or RBBB

A

No driving

68
Q

Driving- PPM implant?

A

Private: 1 week post implantation

Commercial: 1 month post implantation

69
Q

ICD? Primary prevention

A

Private: 4 weeks

Commercial: Never

70
Q

ICD- Secondary prevention

A

Private: 6 months no therapy

Commercial: never

71
Q

ICD: Secondary prevention but no VT with LOC

A

1 week + interval associated with VT

Commercial: never

72
Q

EP study?

A
  • Private: 48h

- Commercial: 1 week

73
Q

1 episode vagal syncope, recurrent < 12 months?

A
  • Private: no restriction, 1 week

- Commercial: 1 week, 12 months

74
Q

Syncope treated with pacemaker?

A

1 week, 12 months

75
Q

Unexplained syncope 1 episode, recurrent < 12 months

A

Private: 1 week, 3 months

Commercial: 12 months, 12 months

76
Q

NYHA 1 or II, III, IV

A

1 or 2: none

III: None, never

IV: never

77
Q

Heart transplant

A

Private: ok to drive 6 weeks out with NYHA 1 or 2

Commercial: 6 months, LVEF >35%, no ischemia

78
Q

LVAD

A
  • Private: 2 months, NYHA I-III

- Commercial: Never

79
Q

HCM

A
  • No LOC

- Wall thickness < 30, no syncope, No NSVT, No fmaily history of sudden death, no decreased BP on ecercise

80
Q

When can you fly post MI?

A

6-8 weeks

81
Q

When can you fly post ICD

A

1 month post ICD therapy associated with presyncope or syncope

82
Q

What patients need to fly with O2?

A
  • PaO2 < 70mmhg
  • CCS III/IV
  • NYHA III/IV
  • Cyanotic CHD
  • PHT leading to right heart failure
83
Q

8 CV consequences of HIV?

A
  • Myocarditis
  • DCM
  • Accelerated athero
  • Dyslipidemia
  • CV tumor/mets
  • Pericardial effusion
  • Lipodystrophy
  • Pulmonary Htn
84
Q

Kawasaki CV manifestations? (8)

A
  • Pericardial effusion
  • Myocarditis
  • MI
  • Aortitis
  • AR
  • HF
  • Arrhythmias
  • Coronary Arteritis
85
Q

5 CV manifestations of RA?

A
  • Pericarditis
  • Pericardial effusion
  • Valvular lesions
  • Aortitis
  • Myocarditis
  • Pulm HTN
86
Q

Cv manifestations of SLE? (6)

A
  • Libman sachs IE
  • Pericardial disease
  • Myocarditis
  • PHTn
  • Aortitis
  • Congenital heart block
87
Q

4 CV manifestations of Ank spond?

A
  • Aortic root dilatation
  • AR
  • Accelerated CAD
  • Blocks
88
Q

5 CV manifestations of Scleroderma?

A
  • PHtn
  • DD
  • Microvascular ischemia
  • Htn/Crises
  • Pericarditis
89
Q

Indications for PPM in muscular dystrophies? (2)

A
  • 3rd or 2nd degree heart blocks

- any degree of heart block in patients with limb-girdle, steinert or kearns-sayre syndrome

90
Q

What is inheritance of Becker and duchenne dystrophy?

A

X linked

91
Q

What kind of CMO do muscular dystrophies cause?

A

-Dilated CMO with arrythmias and conduction system disease

92
Q

ECG findings for duchenne? (4)

A
  • increased R/S ratio V1
  • Q wave in left precordials
  • Short PR
  • RVH
93
Q

What are potential CV implications from trauma?

A

-Cardiac contusion
-Arrhythmias
-Tamponade/Effusion
-Free wall rupture
-VSR
-Ruptured Chordae
-Pap muscle rupture
(think of all mechanical complications of MI)

94
Q

CV implications from electrocution? (5, alot of overlap)

A

Cardiac Arrest

Myocardial injury

Ischemia

Arrhyhtmias

Dysautonomias

95
Q

How does cocaine work?

A

Inhibition of presynaptic reuptake of NE and Dopamine

96
Q

8 ways to management beta blocker toxicity/overdose?

A
  • Glucagon (reverse BB)
  • IV calcium
  • Vasopressors (Epi)
  • High dose insulin and glucose

IV fat emulsion

  • Sodium bicarbonate
  • Pacemaker
  • IABP/VAD
  • IHD (to dialyse Atenolol, Nadolol, Sotalol, Acebutolol)
97
Q

How to manage CCB overdose?

A
  • IV calcium
  • Glucagon
  • High dose insulin/Glucose infusion
  • Vasopressor
  • IV fat emulsion
  • VADs, PPM as needed
98
Q

What are 4 extracardiac manifestations of Digoxin poisoning?

A
  • Visual disturbance
  • GI upset
  • CNS ataxia/stroke symptoms
  • Hypekalemia
99
Q

What is MOA digoxin poisoning?

A

-Increased intracellular calcium leads to delayed after depolarizations, increased automaticity, increased vagal tone

100
Q

ECG findings of Dig poisnong?

A

-U waves, scooped ST segments, Blocks, VT, Short QTc, T wave flattening

101
Q

Management of Dig poisoning?

A
  • ABC’s MOVIE
  • Correct Hypokalemia/Mg (potentiates arrhyhtmic MOA)
  • Do not correct Hyper K (corrected by Digibind)
  • Digibind Indications: Arrhythmias, ARF/LOC, HyperK > 5
102
Q

What is Digibind dose?

A
  • 10 vials for acute poisoning

- Chronic poisoning: Number of vials = serum concentration x Patient’s weight/ 100

103
Q

What are 3 calcifications of Hyperparathyroidism?

A
  • Short Qt
  • Increased contractility
  • Calcification of valves
104
Q

What are 4 effects of hyperthyroidism?

A
  • High output state/CMI
  • Decreased systemic resistance
  • Systolic Hypertension
  • Tachycardia
  • Vasospasm
105
Q

What are 7 effects of hypothyroidism ?

A
  • Low output state
  • Increased systemic resistance
  • Sinus bradycardia
  • Diastolic hypertension
  • Prolonged QT
  • Pericardial effusion
  • Hypertriglyceridemia
106
Q

What are 5 effects of Pheochromocytoma?

A
  • Hypertensive surges
  • Concentric LVH
  • Myocarditis
  • CMO similar to Takotsubo
  • Tachycardia
107
Q

What are 3 ECG findings in Beckers/Duchenne dystrophy?

A
  • Prominent R wave in V1 (Increased R/S ratio)
  • Q waves in left precordial leads
  • Short PR
108
Q

What are three cardiac manifestations of Myathesthenia gravis?

A

-Myocarditis, arrhythmias, blocks

109
Q

What are 5 manifestations for CNS catastrophe?

A
  • ST changes
  • TWI
  • Long QT -> tdp
  • Takotsubo CMO
  • Acute pulmonary edema
110
Q

5 mechanisms of MI with Cocaine use

A
  • Increased demand
  • Increased platelet aggregation -> Plaque rupture
  • Coronary dissection
  • Coronary vasospasm
  • Accelerated CAD
111
Q

What are 5 non coronary effects of cocaine use?

A
  • Takotsubo CMO / DCM
  • Arrythmias
  • Aortic dissection
  • Hypertensive surges -> LVH
  • Myocarditis
112
Q

What are 4 non cardiac implications in Beta blocker poisoning?

A
  • Altered LOC
  • Seizures
  • Hypoglycemia
  • Bronchospasm
113
Q

What are 4 mechanisms of Digoxin induced arrhythmia?

A
  • Delayed after depolarizations
  • Increased Automaticity
  • Increased Vagal tone
  • Associated hyperkalemia

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