UBC RCE Compiled Notes Flashcards
What is Non HDL comprised of? How is it calculated?
-The sum of chylomicron remnants, VLDL, LDL, Lp(a), LDL
-Calculated on a lipid panel by subtracting HDL from the total cholesterol
Who should be screened for lipid profile? (7)
Everyone over 40 years old
< 40 years old when:
-Clinical ASCVD
-Evidence of Hyperlipidemia (On physical exam)
-CV Risk Factors
-ED
-COPD
-Post menopausal women of women with history of hypertensive disease of pregnancy
Should screening lipids be fasting?
yes, unless G > 4.5 mmol/l
Friedewald: TC = TC - HDL - (TG x 0.45)
When does lipid screening need to be repeated based on FRS
Every 5 years if FRS < 5%, Annually if FRS > 5%
In IR patients, name reasons to start on statin therapy (11)
LDL > 3.5
APO B > 1.05
NON HDL > 4.3
> 50M/60W with one of the following: IFG, Low HDL, High waist circumference, HTN, Smoker
CAC > Non zero
CRP > 2
Lp(a) > 50 mg/dl
What is the most important health intervention for prevention of CVD?
Smoking cessation
What % of total saturated fats should be of total energy
< 9%
What is healthy body weight?
BMI 18.5-25
What target organ damage should prompt BP treatment in office (not hypertensive crisis)
-CAD (ASCVD, HF, LVH)
-CVD
-Hypertensive Retinopathy
-PAD
-CKD (eGR < 60 or Albuminuria)
Patients should have 2 or more of the following to screen for Renovascular Hypertension?
- < 30 years or >55 years worsening or new onset HTN
- Abdominal Bruit
- Cr up by 30% or more with ACEi
- Recurrent Pulmonary Edema with ACEi
- Hypertension resistant to three drugs including a Diuretic
-Other ASCVD established
4 Imaging modalities to evaluate for RAS?
CTA
MRA
Doppler US
Captopril-enhanced radioisotope renal scane
When should FMD be screened for? 4 ways different than Renovascular
-Positive fmaily history of FMD
-FMD in another vascular territory
-Abdominal bruit without apparent atherosclerosis
-1.5 cm difference between kidney size
What test to do after FMD diagnosed?
-Cervicocephalic lesions and intracranial aneurysm
4 reasons to screen for Hyperaldosteronism?
Diuretic induced Hypo K < 3.0
Spontaneous K < 3.5
Incidental adrenal adenoma
Resistance with 3 or more drugs
Approach to diagnosing Hyperaldosteronism
-Plasma renin:aldo ratio
-Saline suppression (2L over 4h) -> positive if Aldo > 280 OR Captopril suppression test
-Adrenal imaging and Adrenal Vein sampling
WC targets for Men and Women?
Men < 102 cm
Women < 88 cm
Three agents to use for isolated systolic hypertension
-Thiazide
-ARB
-CCB
What is the criteria for Metabolic syndrome?
Three or more of the following:
-WC > 102 for men, > 88 for women
-BP > 130/85mmhg
-TG > 1.7 mmol/l
-HDL < 1 (men), < 1.3 (women)
-Glucose > 5.6
Which patients undergoing non cardiac surgery should you screen?
- > 45 years
- Known CVD
What is the RCRI components ? What does it predict?
Predicts 30 day MI, Cardiac arrest, Death following non cardiac surgery
-Cerebrovascular Disease
-Diabetes on Insulin
-CKD Cr > 177
-HF
-CAD
-High risk surgery (intraperitoneal, supra-inguinal vascular, intrathoracic)
Three criteria to proceed with NT BNP testing with Pre op testing? What is BNP cut off?
-Age > 65 years
-RCRI 1 or more
-Age 45-64 with CV condition (CAD, CVD, PAD, Severe PHTN, AS, HOCM, MS)
BNP < 92, NT BNP < 300
What effect does Exercise have on Lipid profile?
-Increase HDL, Decrease LDL, Decrease TG’s
What is resting membrane potential for myocyte membrance?
-70 to -90 mV
What is an example of early after depolarizations? delayed?
-Early: QTC
-Late: Dig toxicity, Ischemia, CPVT, Outflow tract arrhythmias