Unit 2 Day 6 (Tue 4/14) Flashcards
Secondary Prevention
- needed for pts with confirmed CAD or vascular equivalent
- prevention of plaque rupture and progression is the goal
Risk Factors That Contribute to Current Cardiac Stress
- diabetes confers same mortality risk as prior MI
- smokers have 60% higher rates of all cause and cardiac mortality
- smoking cessation reduces CV risk
- obesity appears to facilitate the risk factors for cardiac disease
Classification System (I, IIa, IIb, III)
I- should do it
IIa- reasonable
IIb- might be considered
III- don’t do it
Levels of Evidence (A, B, C)
- A- several randomized trials
- B- observational studies, case reports
- C- expert opinion
Class I Antiplatelet Guidelines
• Aspirin 75-162mg daily for all CAD patients!
• Thienopyridines in all patients with ACS or PCI for one
year following the event, in addition to aspirin 81-325mg
• For post-bypass surgery patients, aspirin 100-325mg for at least one year
• For post-stroke patients, aspirin alone (75-235mg), clopidogrel alone (75mg), or combined aspirin/ dipyridamole (25mg/200mg) daily chronically
• For symptomatic (not asymptomatic) peripheral arterial disease patients, aspirin alone (75-235mg) or clopidogrel alone (75mg)
• If the patient requires warfarin for another indication (e.g. AF), then continue low-dose aspirin 75-81mg and monitor closely for bleeding
Class 1 and IIa BB Guidelines
Class I beta-blocker guidelines
• Beta-blockers in all with LVSD (ejection fraction <40%) even in the absence of heart failure symptoms
• Beta-blockers in all with any history of MI/ ACS
Class I RAAS Inhibition Guidelines
- ACEIs
* All with LVSD (ejection fraction 5.0 mEq/L)
2013 Class I Lipid Guidelines
• Statins in all CAD patients
• High-dose (atorvastatin 80mg or rosuvastatin
20-40mg) in patients ≤75yo
• Moderate-dose (atorvastatin 10-20mg, rosuvastatin 5-10 mg, pravastatin 40-80 mg, simvastatin 20-40 mg) in patients <75yo
• No need to titrate to LDL
• No indication for non-statin lipid-lowering therapies
(except potential ezetimibe)
• Not proven in HF NYHA Class III-IV or hemodialysis patients
• Myopathy/myalgias in ~5-15%; unclear relationship
• New-onset DM in 0.1-0.3%, rhabdo in 0.01%, hemorrhagic CVA in 0.01%
Class I, IIa, IIb Diabetes Guidelines
Class I diabetes guidelines
• Lifestyle modifications and coordination with the patient’s primary care physician should occur
Class IIa diabetes guidelines
• Metformin should be a first-line pharmacologic therapy
Class IIb diabetes guidelines!
• HbA1c <7% can be considered
Class IIa, IIb, Depression Guidelines
Class IIa depression guidelines
• Assessment of depression is reasonable
Class IIb depression guidelines
• Treatment for depression does not appear to improve cardiac outcomes, but is beneficial for overall mental health
Class I Smoking Guidelines
- stop, completely, now
- no exposure to second hand smoke
Class I Weight Control Guidelines
- Goal BMI is 18.5-24.9
- Goal waist circumference is <35 inches for women
- Initial goals of weight loss should be 5-10% of body weight
Class I Physical Activity Guidelines
- Moderate to high-intensity exercise for 30-60 minutes/day!
* At least 5, and ideally 7, days a week!
Name the four main regions of the heart present during the 4th week of development and their anatomic correlate.
- truncus- aortic and pulm valves, asc. aorta, pulm truck
- bulbus cordis- trabeculated portion of RV
- primitive ventricle- trabeculated portion of LV
- primitive atra- L and R atria
Patent Ductus Arteriosus
- ductus arteriosus is persistence of the distal portion of the left 6th aortic arch
- inc. incidence of persistence in premature infants and infants born at high elevations, also in maternal rubella infection
- functional closure of ductus usually occurs 10-15 hrs after birth
- patent means ductus has stayed open due to prostaglandins and PGE2
