Preventative Cardiology Flashcards
Smoking Cessation
eventually reduces risk of CV dz to that of non-smoker (w/in 15 years)
High intensity Statin
atorvastatin 40-80mg
rosouvastatin 20-40mg
When to start BP Therapy
2 or more readings >140/90 (<80yo)
>80yo = >150/90
If +CVA, CAD, TIA, PAD, AAA, DM, CKD >130/80
Smoking cessations
- Buproprion
- Varenicline if history of SEIZURES (ie on keppra)
(can cause depression/loss of focus- d/c if this happens)
HIV Cardiomyopathy
Protease inhibitors worsen lipid profile
NO simvastatin or lovastatin
Liptor 10 or crestor 10 indicated (low dose statins)
Treat TG>500
OSA - untreated risks
r/o Afib
inc’d risk of SCD during sleep only
Cholesterol guidelines
1) individuals with known clinical ASCVD defined as CHD, stroke, and peripheral arterial disease
2) primary elevations of LDL-C ≥190 mg/dl (i.e., familial hypercholesterolemia)
3) individuals with diabetes ages 40-75 years with LDL-C 70-189 mg/dl and without clinical ASCVD
4) individuals ages 40-75 years without known clinical ASCVD or diabetes with LDL-C 70-189 mg/dl and estimated 10-year ASCVD risk >7.5%.
(all high intensity statin DESPITE baseline LDL levels)
Moderate-intensity statin therapy should be used when high intensity is contraindicated, when characteristics predisposing to statin-associated adverse effects are present, and for patients with ASCVD who are ≥75 years of age
Saxaglipin
inc’d risk of HF hospitalization
Niacin
increases HDL but does not improve survival or decrease CV events
Rheumatic fever and carditis
secondary prevention - abx
Athletic screening
No indication for routine ECG in otherwise healthy patients - just results in unnecessary additional testing
Lifestyle changes
smoking cessation
excercise
diet
weight loss
Cardiac Dyspnea
elevated PCWP
low CO
right to left shunting of blood
Statins & CK
check baseline at beginning
don’t check again unless muscular sx
Primary HTN
most have this
2nd testing for resistant HTN, HTN at young age, new HTN at older age
Tx for BP
> 20/10 (>160/100) above goal (usually <140/90) then start with TWO drugs
1) ACE/ARB (not in AA first)
2) dihydropine CCB ie norvasc (AA)
3) thiazide or thiazide like diuretic (AA)
Dihydropyradine CCB
amlopidine
feldopine
nifedpine
Non-dihydropyradine CCB
Verapamil
Diltiazem
Cardizem
Combination anti lipid tx
Do not combine statin with gemfibrozil
Young patients with HTN
Pt with family Hx HTN and elevated K+ -check renin/aldo - rule out hyperaldosteroneism Pt with BP diff in upper and LE -r/o coarct with MRA/CTA aorta Pt with h/a, flushing, palpitatiosn -check serum catecholamines r/o Pheo
Preop for vascular surgery (aortic)
Do not excercise if claudication Pharm nuc No pharm if wheezing -> use dob stress echo Adensoine - A2A rct Brochospasm - A2B/A3 rct
Antioxidants
do not benefit secondary prevention ACS
Diet post MI
reduce saturated and transfatty acids (<7% sat fat)
Chol <200mg./day
TG>500
start with Fenofibrate or niacin until TG<500 and LDL can be calculated then recheck LDL and start statin if needed
reduce mortality in ACS and prior CV event patients
Influenza vaccine
BB(post 3 years)/Aldo ant only with reduced EF
Screen for secondary HTN causes
1) Young <25 or old >60 at first HTN
2) abrupt onset HTN
3) HTN crisis episodes
4) Sudden worsening of BP control
Ambulatory BP monitoring
Can detect fluctuations in BP at home
Sleep non-dipping BP
White coat HTN
intermediate risk of CV events between normal and elevated BP
Pt with no clinical ASCVD and risk of MACE <7.5% and NO DM/PAD/AAA
No indication for statins
10 year pooled cohort ASCVD risk equation
more diverse cohort including AA
broader endpoint death from MI, CVA (fatal/nonfatal), CAD
Carotid intimal thickness
NOT indicated for risk assessment of ASCVD
Metabolic syndrome
3 or more
1) BP>130/85
2) Fasting glucose >100
3) Waist >40 M, >35 F
4) HDL<40 M <50 F
5) TG>150
Prognostic factors stress test
Poor exercise capacity - best predictor of cardiac death
Perfusion abn predict ischemic events not death
Prevalanece HF
post age 40 - 1:5 adults (framingham)
