MISC last minute cards for boards Flashcards
MC primary cardiac tumor and where does it classical arise.
They secrete what vasoactive substance which may lead to const. sx
Myxoma
IL-6
second mc primary cardiac tumor and
third mc
lipoma
paplillary fibroelastoma
Where do myxoma’s generally arise
fossa ovalis in the left atrium
Associated syndrome with myxoma (<5%)
Carney complex = myxoma + pigmented skin lesions adnd endocrine overactivity. It is AD
reoccurance after myxoma removed surgically
5-10% need semi annual screening until first 4 years out when this risk decreases.
dumbell appearance of intra-atrial seputm
lipomatous hypertrophy (on both sides of the fossa ovals
cardiac tumor that is common with tuberous sclerosis
Rhabdomyoma
Rhabdomyoma is commonly associated with this genetic condition
tuberous sclerosis
MC primary malignant tumor of the heart
- what is their most common location
sarcoma, the most frequently seen are angiosarcoma
- left atrium
- 2 MC primary malignant tumors
2. MC metastitic tumors (6)
- sarcomas and lymphomas
2. lung, melanoma, breast, renal, esophagus lymphoma/leukemia
3 secondary causes of hyperlipidemia
- nephrotic syndrome
- drugs esp cyclosporine
- hypothyroid
4 clinical ASCVD risk groups and statin strength for its 40-75
- DM - mod (high if ASCVD > 7.5)
- CAD/PAD -high
- ASCVD risk > 7.5% mod (high)
- FH ldl > 190 or > 160 on treatment -high
How define high vs. mod intensity statin and what are they
> 50% reduction in LDL is high intensity.
30 < 50% is mod.
High Lipitor 80 or rosuva 40
Mod atorva 10 or 20 rousva 5 or 10, silva 20-40, prove 40-80, pitta 2-4, lova 40, fluva XL 80
When can use a mod dose statin
ASVD risk > 7.5 or DM without elevated ASCVD risk.
when use lower intensity statin
in general wouldn’t use them
NNT for high vs. low intensity stat
ARR 2.2% 1/.002 = 1 in 40
NNH for causing DM
100.
limit for intermediate ASCVD risk calc for statin
5-7.5% IIa to add a statin
what groups have the ascvd lower risk than calculator
Older with lower comorbidities, East Asian , high SES, hispanics
What additional risk features can get you on a statin if your other things don’t
- ASCVD RISK 5-7.5
- LDL > 160
- HS CRP > 2
- CAC > 300
- ABI > 0.9
Underestimated risk of ASCVD
s. asian
HIV
systemic inflammatory
mod elevated TAG do we need to do anything (ie 220)
Do nothing or increase statin dose to full dose.
ACCORD with fenofibrate +statin
did nothing
Major negative fenofibrate troial
accord. fibrates didn’t change mort
Niacin not only didnt improve mortality with its improved HDL it led to these SE
increased dm (which was likely the problem), infection and bleeding
double statin rule
rule of 6’s, 6% reduction
Zetia imporevit
ACS pts lowered compiste
lowers cholesterol by 20%
pcsk9 are approved for which patients
Those with clinical ASCVD or FH
consensus statement from ACC when can you use a second lipid lowering med
when in one of the 4 risk groups ASCVD, DM, ASCVD risk > 7.5%, or FHish with LDL of >=190 and lipids not at goal (>70) or didn’t get a 50% reduction
can’t use ascvd risk calc for 10 yr risk until
40
3 genes for FH
LDL-R, apoB, PCSK9
LDL for herterozygous and homozygous FH
hetero 190-400 (1:250), homo > 400 (1:400)
definite dx of FH on PE
tendinous xanthoma
when niacin, omega 3, or fibrates use based on current gl
only in extreme hyper tag based on current guidelines
