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Cardiology EECC > Prevention, Rehabilitation and Sport > Flashcards

Prevention, Rehabilitation and Sport Flashcards

1
Q

General Exercise Recommendations

A
  • 150 mins of moderate intensity exercise of 75 mins of high intensity exercise per week
  • Gradually increase to 300 and 150 mins for additional benefit
  • Spread over multiple sessions per week is preferred
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2
Q

Obesity, HTN and diabetes exercise recommendations

A
  • Obesity, HTN (well controlled) and DM - 3 x week resistance training in addition to moderate intensity aerobic exercise for 30 mins 5-7 times per week

(HTN but high risk or end organ damage - avoid high intensity resistance exercise)

(Uncontrolled HTN, avoid high intensity exercise until BP controlled)

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3
Q

Exercise Risk Assessment in CCS

A
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4
Q

Anomalous coronary arteries and muscle bridges - exercise recommendations

A
  • If ischaemia, sports with moderate or high intensity are not recommended
  • In AOCA with surgical repair, return to sports after 3 months
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5
Q

Aortic Stenosis - exercise recommendations

A

Mild - exercise ok
Moderate - low to moderate intensity exercise ok if LVEF ≥50%
Severe - low ok as long as LVEF 50% and normal BP response to exercise. Competitive sports or moderate or high intensity exercise not recommended

Biscuspid AV - caution if >40mm aorta

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6
Q

Heart Failure - exercise recommendations

A

HFrEF - Before starting sport - optimise risk factors, medical therapy and device therapy

High intensity , endurance or power sports not recommended in HFrEF

HFpEF - moderate exercise ok. Competitive sports can be considered as long as no abnormalities on exercise test

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7
Q

Aortic Regurgitation and Mitral Regurgitation - exercise recommendations

A
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8
Q

Mitral Stenosis - exercise recommendations

A
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9
Q

Sports Risk Assessment in Aortopathy

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10
Q

HCM exercise recommendations

A

High Risk:
- Cardiac symptoms, cardiac arrest or unexplained syncope
- Exercise induced arrhythmias
- Abnormal BP response to exercise
- ESC risk score ≥4%
- Resting LVOT gradient >30%

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11
Q

Arrhythmogenic cardiomyopathy exercise recommendations

A
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12
Q

Mitral Valve Prolapse - exercise recommendations

A

Any one of these factors, avoid high intensity exercise in creased risk of SCD

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13
Q

Myocarditis and pericarditis - exercise recommendations

A
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14
Q

Atrial Fibrillation - Exercise Recommendations

A
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15
Q

SVT - exercise recommendations

A
  • SVT without pre-excitation - exercise is recommended
  • WPW - pre-excitation and arrhythmias - pathway ablation recommended
  • Competetive/ professional athletes with asymptomatic pre-excitation, pathway ablation recommended
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16
Q

LQTS and Brugada Syndrome - Exercise Recommendations

A
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17
Q

HTN - Definitions

A
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18
Q

HTN - Risk Stratification

A

Risk assessment using SCORE system is recommended in all patients not already high risk or very high risk due to established CV disease, diabetes, renal disease, hypertensive LVH or highly elevated single risk factor (cholesterol) (1b)

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19
Q

HTN - office vs ambulatory HTN definitions

A
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20
Q

HTN - screening and diagnosis

A
  • BP should be measured in both arms at first visit as difference of >15 is suggestive of atheromatous disease and increased CV risk
  • BP can be diagnosed either in office or at home:
  • Office - BP measured on more than 1 visit (except when. BP is severe - Grade 3). At each visit, 3 BPs taken, 1-2 minutes apart - do more if first 2 readings >10mmHg different. BP is average of final 2 reading
  • Home - HBPM or ABPM
  • HBPM or ABPM recommended for specific situations - diagnosing White Coat HTN, masked HTN, side effects (symptomatic hypotension)
  • All hypertensive patients should have pulse palpation at rest to screen for AF
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21
Q

HTN - tests

A
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22
Q

HTN - starting treatment

A

*In grade 1 HTN, low-moderate risk, start lifestyle initially, then medication if BP not controlled in 3-6 months

  • In grade 1 HTN, high risk, start medication alongside lifestyle intervention

*Grade 1 HTN >65 (but <80), start drugs and lifestyle as long as well tolerated
* In pts >80, start anti-hypertensive therapy and lifestyle interventions when SBP >160/90

*High normal BP, lifestyle only. If very high risk, consider drugs

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23
Q

HTN treatment targets

A
  • BP <140/90 is first priority, then target ≤130/80 in most patients
  • If <65 and tolerating therapy, aim for 120-129 SBP
  • If ≥65, aim for130-139 SBP at all levels of CV risk. Monitor for side effects
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24
Q

HTN - lifestyle recommendations

A
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25
Q

HTN - medical management in uncomplicated HTN

A
26
Q

HTN - medical management in HTN with CAD

A
27
Q

HTN - medical management in HTN with renal disease

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28
Q

HTN - drug management recommendations

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29
Q

Secondary HTN - suggestive features

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30
Q

Secondary HTN - causes and screening investigations

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31
Q

Rare genetic causes of secondary HTN

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32
Q

Hypertensive Emergencies

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33
Q

HTN in pregnancy

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34
Q

Lipids - Very high risk and high risk patients

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35
Q

Lipids - Moderate and Low Risk Patients

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36
Q

Lipids - intervention strategy based on SCORE and LDL-C

A
37
Q

Lipids - recommendations for cardiovascular risk estimation

A
  • Use risk estimation calculator such as SCORE for asymptomatic adults >40 without evidence of CVD, CKD, DM, FH or LDL-C >4.9mmol/L
  • High and very high risk individuals should be identified by documented CVD, DM, moderate-severe renal disease, very high individual risk factors, FHx or a high SCORE risk.
  • SCORE risk calculators should not be used in FH or DM
38
Q

Lipids - LDL-C calculation from TC, HDL and TGs

A
39
Q

Lipid analyses in cardiovascular risk estimation

A
40
Q

Lipids - LDL treatment goals

A
41
Q

Lipids - Pharmacological Therapy

A
42
Q

Lipids - Treatment Algorithm for Lipid Lowering

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43
Q

Treatment Goals in CV disease prevention

A
44
Q

Guidelines for drug treatment in patients with hypertriglyerceridaemia

A
  • Statins first line to reduce risk in patients with TG levels ≥2.3mmol/L (>200mg/dL)
  • In high risk pts with TG levels 1.5-6, consider icosapent-ethyl (n3-PUFAs)
  • In primary prevention and high risk patients on statin with LDL at target but TG >2.3 consider adding Fenofibrate/ Bezafibrate
45
Q

Familial hypercholesterolaemia

A
46
Q

FH recommendations

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47
Q

Lipid Lowering Therapy Post ACS

A
48
Q

Lipids - monitoring lipids and enzymes before and on lipid lowering therapy

A
49
Q

Primary Prevention - Guidelines on Assessing Risk

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50
Q

Primary Prevention - Approach to apparently healthy person

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51
Q

Risk Factor Management in Patients with Established ASCVD

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52
Q

Risk Factor Management in Patients with Diabetes

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53
Q

Prevention - Treatment Goals

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54
Q

Risk Category Definitions

A
55
Q

HTN - treatment targets

A
56
Q

Core drug treatment strategy in HTN

A
57
Q

Prevention - recommendations in diabetes

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58
Q

Prevention - anti-thrombotic therapy

A

*Aspirin recommended for secondary prevention of ASCVD

*Clopidogrel alternative if aspirin intolerance

*Give PPI with aspirin if high bleeding risk

  • DM and high or v high CV risk - give aspirin for primary prevention
  • Aspirin NOT recommended for prevention in patients with low/moderate CV risk due to risks of bleeding
59
Q

Prevention - CKD

A
60
Q

Athlete ECG

A

TWI present in 12% of Black athletes

Inferolateral TWI - high likelihood of cardiomyopathy - needs further investigation

Cardiology EECC (17 decks)

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