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6030 Primary Care Test 2 Complete ☑️ > Module 4 (b) > Flashcards

Module 4 (b) Flashcards

1
Q

CAD

-Differentials and DX

A
  1. CAD is a dx that has to be made w/ OBJECTIVE Testing
    - Positive stress test w/ follow up LHC to show obstructive vs non-obstructive dz
    - Hx of CABG
    - Hx of coronary stents
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2
Q

Chest pain

-Diagnostic Testing

A
  1. ECG
    - Refer to cardiology or ER
  2. Cardiology Dx Testing:
    - Exercise stress test
    - Echocardiogram w/ suspicion of CHF
    - Coronary angiogram (Cardiac catheterization); Left Heart Catheterization
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3
Q

CAD Treatment

A
  1. Risk factor reduction
  2. Lifestyle modification
  3. Exercise
  4. Cardiac rehab
  5. Cardiology input
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4
Q

CAD: Medical Management

A
  1. ASA
  2. Plavix, Effient vs Brillenta (MUST BE ON blood thinner post stent placement
  3. Tight BG control w/ DM
  4. BB
  5. ACE-I or ARB
  6. CCB
  7. Follow up
  8. Need a statin
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5
Q

CAD: Medical Management

-Stent Management

A
  1. Bare metal stent recommended for 3 months
  2. Drug eluding stent recommended for 1 year
    - Surgery needs to be done in a facility with cath lab with drug eluding stent d/t risk of clotting
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6
Q

CAD

-When to Refer

A
  1. New Pt w/ hx of cardiac intervention seen by Cardiologist once a year
  2. Condition is complicated w/ multiple co-morbidities
  3. Change in angina
  4. Hx of coronary ischemic syndrome
  5. Symptoms and comorbidities dz should determine frequency of visits to specialist
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7
Q

Heart Failure

-Definition

A

A complex clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to FILL with blood or EJECT blood.

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8
Q

Heart Failure

-Patho

A
  1. Myocardial insult
  2. Myocardial dysfunction
  3. Reduced Organ perfusion
  4. Renin-Angiotensin-Aldosterone activation
  5. Remodeling
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9
Q

Heart Failure

-Treatment Goal***

A

ALL oral therapy to reduce morbidity and mortality is aimed at:
1. SLOWING or STOPPING the sympathetic activation in the renin-angiotensin-aldosterone system **

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10
Q

Heart Failure

-LVEF

A

Normal is >55%

1. Measures how well heart is pumping

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11
Q

Heart Failure

-LVEF = 40-45%?

A
  1. Heart failure w/ reduced EF is HF with EF = 40-45%

- Mid range of 45-50% you treat as HFrEF

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12
Q

Heart Failure

-Risk Factor for HFpEF

A
  1. HTN (with prevalence of 60-89%)
  2. Obesity
  3. DM
  4. A fib
  5. Hyperlipidemia
  6. Older age

HFpEF= preserved EF greater than 50%

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13
Q

Heart Failure

-Risk factors for HFrEF

A
  1. HTN
  2. Diabetes
  3. Metabolic syndrome
  4. Atherosclerotic dz
  5. Valve dz
  6. Dilated cardiomyopathy
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14
Q

Heart Failure

-Precipitating Event

A
  1. CAD is cause of HF in 2/3 of patients w/ systolic dysfunction
  2. Most patients w/ HF (70%) have systolic dysfunction HFrEF
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15
Q

Heart Failure

-ACC/AHA HF Stages

A
  1. A
    - High Risk w/ No structural disease
  2. B
    - Structural heart DZ w/ no HF symptoms
  3. C
    - Structural heart DZ w/ Prior or current HF symptoms
  4. D
    - Refractory end-stage HF requiring special interventions
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16
Q

Heart Failure

-NYHA Functional Class (Talks about Symptoms)

A
  1. Class 1
    - Asymptomatic
  2. Class 2
    - Symptomatic w/ moderate exertion
  3. Class 3
    - Symptomatic w/ minimal exertion
  4. Class 4
    - Symptomatic at rest
17
Q

Heart Failure

-Common Symptoms

A
  1. Orthopedic
  2. Dyspnea at rest and on exertion
  3. Reduced exercise capacity
  4. Ascites
  5. Scrotal Edema (Nephrotic syndrome or HF)
  6. Paroxysmal Nocturnal Dyspnea PND — wake up SOB
18
Q

Heart Failure

-Uncommon Symptoms

A
  1. Wheezing or cough
  2. Confusion/delirium
  3. Depression/weakness (especially elderly)
  4. Unexplained fatigue
  5. GI symptoms
    - RUQ abdominal pain can be HF
19
Q

Heart Failure

-Differential Dx

A
  1. MI
  2. Pulmonary dz
  3. Sleep disordered breathing
  4. Obesity
  5. Malnutrition/ anemia
20
Q

Treatment of HFrEF

-Guideline Directed Medical Therapy (reduced mortality)

A
  1. ACE-I or ARB or ARNI
  2. Beta Blocker
  3. Aldosterone antagonist
  4. Hydralazine/isosorbide (For African Americans and those who cannot tolerate ACE-I/ARB)
    - Add hydralazine/isosorbide to all the above w/ AA for significant benefit
  5. SGLT2i**
21
Q

Treatment of HFrEF

-Guideline Directed Medical Therapy (reduced symptoms**)

A
  1. Loop Diuretics
  2. Potassium supplements if needed for loop diuretics
  3. DIgoxin to reduce hospitalization
  4. Thiazide diuretics can be added to boost loop diuretics

These meds are for SYMPTOMS NOT MORTALITY

22
Q

AFIB

-Anticoagulation w/ cardioversion

A
  1. When the rhythm has been sustained for longer than 48 hrs, anticoagulation therapy should be uninterrupted for 4 weeks before and for at least 4 wks after elective cardioversion
  2. TEE used to evaluate thrombosis before cardioversion
23
Q

Afib

-CHA2D2-VASc Score?

A
  1. CHA2D2-VASc Score of 2 or greater in men and 3 or greater in women
    - Oral anticoagulants are recommended
24
Q

Afib

-Anti-coagulants (NOACs)

A
  1. Pradaxa
  2. Eliquis
  3. Xarelto
  4. Savaysa

No INR needed

25
Q

Afib

A
  1. Refer a pacemaker to a specialist. DO not manage in clinic
26
Q

PVD

-Smoking

A

Smokers are twice as likely to develop PVD than non-smokers

27
Q

PVD Limb Pain

-Venous Pain

A
  1. Decreased w/ elevation
  2. Better with walking
  3. Pain localized at sight of vein
28
Q

PVD Limb Pain

-Arterial Pain

A
  1. Relieved with rest
  2. Increased with elevation
  3. Worse with walking
  4. Pain in regional areas of arterial flow
29
Q

PVD

-Buerger’s Dz

A
  1. Specific to young male smokers
    - Can lose digits & limbs
    - Resolves when smoking is stopped
30
Q

PVD

-When to refer

A
  1. No pulse

2. Ankle brachial index

31
Q

PVD

-AnkleBrachial Index ** Exam

A
  1. Noncompressible >1.30
  2. Normal = 0.91-1.30
  3. Mild to Moderate PAD = 0.41-0.90
  4. Severe PAD = 0.00-0.40

TEST

32
Q

Valve Disease

-Key Diagnostics

A
  1. Cardiac Murmur

2. Symptoms (SOB, dizziness, syncope)

33
Q

Valve Disease

-Aortic Stenosis

A
  1. Elderly patients can develop aortic stenosis
    - Can progress to symptoms
  2. Aortic Stenosis murmur is heard best at the Right sternal border 2nd intercostal space
    - Radiate to the neck as a brui

REFER

34
Q

Valve Disease

-Medical MgMt

A
  1. Manage other risk factors such as DM, HTN, Hyperlipidemia
  2. DO NOT start a new exercise program
    - See cardiology prior to starting a new exercise program **

6030 Primary Care Test 2 Complete ☑️ (8 decks)

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