Secondary Prevention of Heart Disease Flashcards
When is secondary prevention in cardiac patients necessary? What are the goals for secondary CV prevention?
Whenever a patient has had a previous cardiovascular event. Goals: prevent plaque progression and rupture.
What are the 2 pathways for antiplatelet treatment in secondary prevention?
- Thromboxane synthetase inhibitors (TSIs such asAspirin 81mg)
- P2Y-12 antagonists, which block ADP receptors (clopidogrel, prasugrel, ticagrelor)
True or False:
P2Y-12 antagoinsts and TSIs are frequently used together
True:
Especially for a year after a CV event.
If a recommendation is catergorized as a IIa C, what does that mean?
IIa= reasonable to do C= (expert opinion)
I- Should do it to all pts
IIa- Reasonable
IIb- Should consider it
III- Should NOT do
A- supported by several Randomized Controlled Trials
B- Observational studies/case reports
C-expert opinions
What class recommendation is aspirin? When is it indicated?
Class I- Should be used daily for Coronary Artery disease (CAD) patients.
When should a P2Y-12 Antagonist be added to daily aspirin treatment?
Clopidogrel should be added for a full year following any CV event or stent placement.
What are the guidelines for using Beta-blockers in treatment of secondary prevention?
Class I- ALL people with LVSD (EF <40%)and HF symptoms; or in people who have had MI/ACS in the least 3 years
Class IIa-for people with LVSD/EF<40% even without HF symptoms; in people with any history of ACS/MI.
What are the guidelines for using RAAS inhibitors in treatment of secondary prevention?
Class I- ACEIs or ARBS for peeps with LVSD, Diabetes Mellitus , HTN, kidney disease and HF Symptoms.
True or False:
A patient with Diabetes Mellitus should be put on RAAS inhibitors even WITHOUT having a prior CV event.
TRUE
Diabetes is so closely associated with CV disease that you treat anyways.
What are the contraindication to treating a patient with RAAS inhibitors?
Renal Dysfunction or Hyperkalemia. Remember RAAS inhibitors are K sparing drugs.
What are the 5 major pharmacologic + lifestyle interventions for secondary prevention?
- Reduce Blood Pressure 2. Reduce Cholesterol 3. Glycemic Control 4. Depression management 5. Smoking
According to the 2011 guidelines, what is the “target blood pressure” that patients need to achieve to have reduced risk of CV disease?
We will be tested on these numbers:
- Under 60- 140/90
- Over 60- 150/90
Not these ones:
For your gee-whiz collection, new data supports getting BP down to 120/80 but this has not been reflected in guidelines as of yet. YOU WILL NOT BE TESTED ON THE 120/80 KNOWLEDGE.
What are recommendations for reducing cholesterol?
Class I- High Dose Statins to ALL pts with CVD under 75.
Class IIa- Moderate dose statins to pts over 75.
True or False: reducing blood sugar levels in patients doesn’t reduce MI outcomes.
TRUE.
Although you would have beneficial changes in other aspects of life, reducing blood sugar levels does not reduce MI outcomes.
What are the guidelines for managing blood glucose levels (diabetes)?
Class I- Lifestyle changes
Class IIa- Metformin Class IIb- Fix HbA1c
