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Week 1 Flashcards

1
Q

What do the following diseases put you at risk for?
Coronary Artery disease (puts you at risk for what)?
CardioVascular Disease?
Peripheral Artery Disease?

A

CAD - MI

CVD - Stroke

PAD - Thrombosis/Necrosis

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2
Q

What is the most common cardiovascular disease

A

Hypertension

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3
Q

Have total CVD, CHD and stroke deaths increased or decreased?

A

Decreased

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4
Q

Have the total number of heart failure incidences increased or decreased?

A

Increased

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5
Q

What is the number one exit diagnosis in hospitals today?

A

Heart Failure

increased mortality due to HF

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6
Q

What percentage of americans have no identifiable modifible risk factors for CVD?

A

40%

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7
Q

What does FLASHED stand for?

A 
Family History
Lipids
Age (regardless of gender, once 50+, risk of CVD = age)
Smoking
HTN
Exercise
DM
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8
Q

What is Heart Rate Variability

A

Fluctuation in the length of time between R-R intervals

  • MOST ACCURATE method of analyzing autonomic tone
  • Measures R-R interval
  • Directly affected by stress

“valleys” on HRV represent the shortest RR intervals and therefore SNS

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9
Q

What are the components of freeze frame (5) and what is it used for?

A
  1. Take time out to recognize internal stress
  2. Heart Focus: away from mind, breath into heart
  3. Recall: a positive place
  4. Ask how you can respond more efficiently
  5. Listen to this

using this can help take you from a state of stress and anxiety and move you to love and appreciation - therefore, it improves HRV! Matching the inhale to the exhale.

Patients most often think the greatest contributor to their heart disease IS STRESS

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10
Q

What does the F stand for in FLASHED and what are the parameters?

A

Family history

  • first degree relative with early cardiac event
  • Early MI = 2x men; 70% women
  • Male relatives: < 55
  • Female : <65

Both parents with MI hx increases your risk
Siblings with MI - risk increase it by 50% (for females)

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11
Q

What are normal limits for HDL in men and women

A

40-80

less than 40 is too low

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12
Q

Age risks for men and women on FLASHED score

A

Males >45

Females >55

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13
Q

Smoking risks on flashed?

A

cigarette smoking in the past month

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14
Q

what does 449 mean?

A

4 c/g protein

4c/g carbs

9c/g fat

Decide what percentage of your diet will be fat/protein/carb; . Multiply this percentage by your Total daily caloric intake to get total intake of that nutrient. Convert this value from Calories to grams by dividing it by 4/4/9;

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15
Q

Does MI risk increase with low or high vitamin D?

Risk factors of vitamin d supplementaton?

A

Low=2xmore risk

High vitamin D=risk of fibrosis

Target range: 50-75 ng/mg

Check every three months

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16
Q

What are the risks of Vitamin K deficiency and excess?

A

Deficiency: Arterial Wall Calcification + Hemmorhage

Excess: Clots

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17
Q

B1/Thiamin deficiency is the most important vitamin for what?

A

PVC’s

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18
Q

Alcohol in excess, also known as holiday heart syndrome gives symptoms of what?

A

Afib and palpitations

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19
Q

Cocaine gives sx of what?

A

PAC, PVC, Coronary spasm, MI

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20
Q

Caffeine gives symptoms of what?

A

Arhythmia

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21
Q

Thyroid replacement gives symptoms of what?

A

Tachycardia, afib, PVC’s

Tsh is important to test in all pts presenting with new irregular heart rate and rhythems especially when tachycardic

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22
Q

What are some sympathomimetic agents and what can they cause

A

Tachycardia and htn

  • ephedra, anphetamines, SNERI(strattera)
  • Tyrosine: increases NE/EPI if given with selenium will see hyperthyroidism at high doses
  • Macuna Pruriens: Increased dopaminew
  • Sumatriptan: Vasospasm induced ischemia
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23
Q

Why is estrogen a risk factor of heart disease?

A

Estrogen status:

-ferritin accumulates as an ooxidant and oxidizes LDL and contributes to ASCVD

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24
Q

Name the 10 modifiable risk factors for heart disease

A
  • Diet
  • Alcohol
  • Drugs
  • Obesity
  • Menopause
  • Metabolic Syndrome
  • Stress
  • Smoking
  • High Cholesterol
  • Other inflammatory disorders (Gout, OA, RA, etc)
25
Tell me about xanthane oxidase
found in raw milk, folic acid blocks it and lowers uric acid
26
What are three risk calculators?
- ASCVD 10 year risk calculator: most uptodate and reccomended, based on FLASHD, 7.5% cut off - Framingham: uses Qx calculate, older - Reynolds risk: includes CRP
27
What questions does Framingham's look at
- Gender - Age - Total Cholesterol - HDL - Systolic BP - BP Meds Y/N? - Smoker - DM - Known vascular dz
28
What are the 4 indications for statin therapy?
1. Clinical ASCVD: hx of mi, stroke, PAD 2. LDL>190mg/dl 3. DM 4. ASCVD risk > 7.5% 40-75 yo
29
Which diet is bet to modify metabolic syndrome?
High potein
30
Which diet is best at decreasing blood pressure therefore is the best for HTN
DASH-S
31
Which diet is the only diet with pre/post angiogram studies/evidence verifying reversal of altherosclerosis and CAD?
Plant based diet
32
Which diet is best for prevention?
Mediteranian
33
What did the omniheart trial show?
Replacement of SFA with pritein or unsaturated fat is more effective than replacement with carbohydrates in improving lipids and reducing blood pressure
34
What did the Lyon Heart Study Show regarding the mediteranian diet
mediterranean diet rich in linolenic acid is more effective than STEP one of the NCEP diet in secondary prevention of CAD
35
What did the medi-rivage study show?
mediterranean diet lowers TC and LDL better than NCEP step I and Step II
36
What did the ornish study show?
Whole foods, vegetarian diet and 10% dfat plus aerobic exercise, stress management, smoking cessation and psychosocial support all decreased cardiac events and coronary stenosis
37
What are Dr. Milners plant based diet guidelines
1st line: 15% fat, 50% raw, no oil, minimal nut butter, avocado, coconut milk 2nd line: 10%fat, 50% raw, same as above but no fish 3rd line: 10% fat, 75% raw, same as above but no avocado either
38
Conventional treatment reccomends at home exercises how often? What does Dr. Milner reccomend?
30 min 5/week Dr. Milner: THR 40-60 minutes everyday want to work up to moderate exercise if cant do longer time periods Goal: 10000 steps daily=5miles
39
How do you calculate someones maximum HR Target Heart Rate?
Max: 220-age Target: 220 - age - resting x .6 + resting
40
How does the THR calculation change if on beta blockers or recent MI?
220 - age - resting x .4 + resting
41
What are some indications for cardiac rehabilitations and what are the components Phases?
- Indications: Post Mi, Stent, CABG, Post transplant, valve replacement, CHF, PAD - Components: medical eval, exercise training, risk factor modification, education, counseling - Phases: in patient, early outpatient, long term
42
When doing Cardiac rehab what is the number one rule
Exercise at a Heart rate that that causes no ST depression or cardiac arrhythia on monitoring or until percieved exertion or THR is met
43
What is the purpose and indications of exercise stress testing
- Purpose: diagnostic procedure to evaluate for coronary artery disease - Indication: chest pain on exertion, patients with increased risk of CAD
44
What happens in a exercise tolerance test, what are the indications?
Put them on a tredmil w/ a EKG, stratefied based on dz severity -Indications: CAD with stable angina, post MI/Stent/CABG/ Post valve-replacement, post CABG
45
What is the purpose and what are the parameteres of exercise tolerance testing:
-Purpose: symptom limited exercise test to determine tolerance leveles based on various paraeters Parameters: target hr, arrhythmia, drop in BP, Drop in puls ox, St segment changes, hemodynamic symptoms, percieved exertion
46
What therapy directly impacts and improves CAD by inducing collateral blood flow and improving endothelial function?
Oxygen Multistep Therapy
47
What is the proceedure, outcomes and contraindications for OMST?
- Proceedure: pt takes nutrients before eercise, exercise at THR x 15 minutes with oxygen at 20-25L/min. - Outcomes: improves oxygen uptake, improves microcirculation, encourages formation of new collateral vessels(Angiogenesis)! - contraindications: CP{D
48
What are indications to preform OMST?
CAD, Post stent, intermittent claddication, increased wound healing, infx, prevent amputation macla degeneration, hepatic fail, migraines, emphysema, asthma, SOB
49
Why does OMST work?
As we age, the arterial pressure of O2 decreased, this decreases O2 in cells OMST increases arterial pressure and tehrefore oxygenation of our cells. Lets make us a youth again!
50
Steps to OMST
1. Spirometry to R/O COPD 2. Exercise tolerence test 3. OMST 3-21 times 2x per week 4. Post-exercise tolerance testing 5. Nutrients before exercise 6. THR and home exercise
51
When Calculating Flashed what is the age range for positive family history
Males <55 | Females <65
52
When Calculating Flashed what is the age range for positive Lipids
Males HDL <40 | Females HDL <50
53
When Calculating Flashed what is the age range for positive age risk?
Males >45 | Females>55
54
What is the target value of vitamin D
50-75 ng/mg
55
Why is tyrosine a risk factor for heart disease
Sympathomimetic agent -Tyrosine: increases NE/EPI if given with selenium will see hyperthyroidism at high doses
56
Why is sumitriptan a risk factor for heart disease?
it can cause vasospasm induced ichsemia
57
What percentage does cardiac rehab reduce mortality rates by?
21-34%
58
What is the exercise risk stratefication index
A: Health B: clinically stable CHD C: moderate high risk of cardiac complications during exercise D: Unstable disease with activity- Do not exercise
59
What is contraindicated in OMST and why
COPD They rely on CO2 to breath, if you give them oxygen it will inhipit they hypocarbic drive, so it will take away their drive to braeth

Cardiology (8 decks)

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