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Cardiology > Week 1 > Flashcards

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
Q

Tell me about xanthane oxidase

A

found in raw milk, folic acid blocks it and lowers uric acid

26
Q

What are three risk calculators?

A
  • 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
Q

What questions does Framingham’s look at

A
  • Gender
  • Age
  • Total Cholesterol
  • HDL
  • Systolic BP
  • BP Meds Y/N?
  • Smoker
  • DM
  • Known vascular dz
28
Q

What are the 4 indications for statin therapy?

A
  1. Clinical ASCVD: hx of mi, stroke, PAD
  2. LDL>190mg/dl
  3. DM
  4. ASCVD risk > 7.5% 40-75 yo
29
Q

Which diet is bet to modify metabolic syndrome?

A

High potein

30
Q

Which diet is best at decreasing blood pressure therefore is the best for HTN

A

DASH-S

31
Q

Which diet is the only diet with pre/post angiogram studies/evidence verifying reversal of altherosclerosis and CAD?

A

Plant based diet

32
Q

Which diet is best for prevention?

A

Mediteranian

33
Q

What did the omniheart trial show?

A

Replacement of SFA with pritein or unsaturated fat is more effective than replacement with carbohydrates in improving lipids and reducing blood pressure

34
Q

What did the Lyon Heart Study Show regarding the mediteranian diet

A

mediterranean diet rich in linolenic acid is more effective than STEP one of the NCEP diet in secondary prevention of CAD

35
Q

What did the medi-rivage study show?

A

mediterranean diet lowers TC and LDL better than NCEP step I and Step II

36
Q

What did the ornish study show?

A

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
Q

What are Dr. Milners plant based diet guidelines

A

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
Q

Conventional treatment reccomends at home exercises how often?

What does Dr. Milner reccomend?

A

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
Q

How do you calculate someones maximum HR

Target Heart Rate?

A

Max: 220-age

Target: 220 - age - resting x .6 + resting

40
Q

How does the THR calculation change if on beta blockers or recent MI?

A

220 - age - resting x .4 + resting

41
Q

What are some indications for cardiac rehabilitations and what are the components

Phases?

A
  • 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
Q

When doing Cardiac rehab what is the number one rule

A

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
Q

What is the purpose and indications of exercise stress testing

A
  • Purpose: diagnostic procedure to evaluate for coronary artery disease
  • Indication: chest pain on exertion, patients with increased risk of CAD
44
Q

What happens in a exercise tolerance test, what are the indications?

A

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
Q

What is the purpose and what are the parameteres of exercise tolerance testing:

A

-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
Q

What therapy directly impacts and improves CAD by inducing collateral blood flow and improving endothelial function?

A

Oxygen Multistep Therapy

47
Q

What is the proceedure, outcomes and contraindications for OMST?

A
  • 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
Q

What are indications to preform OMST?

A

CAD, Post stent, intermittent claddication, increased wound healing, infx, prevent amputation macla degeneration, hepatic fail, migraines, emphysema, asthma, SOB

49
Q

Why does OMST work?

A

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
Q

Steps to OMST

A
  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
Q

When Calculating Flashed what is the age range for positive family history

A

Males <55

Females <65

52
Q

When Calculating Flashed what is the age range for positive Lipids

A

Males HDL <40

Females HDL <50

53
Q

When Calculating Flashed what is the age range for positive age risk?

A

Males >45

Females>55

54
Q

What is the target value of vitamin D

A

50-75 ng/mg

55
Q

Why is tyrosine a risk factor for heart disease

A

Sympathomimetic agent

-Tyrosine: increases NE/EPI if given with selenium will see hyperthyroidism at high doses

56
Q

Why is sumitriptan a risk factor for heart disease?

A

it can cause vasospasm induced ichsemia

57
Q

What percentage does cardiac rehab reduce mortality rates by?

A

21-34%

58
Q

What is the exercise risk stratefication index

A

A: Health

B: clinically stable CHD

C: moderate high risk of cardiac complications during exercise

D: Unstable disease with activity- Do not exercise

59
Q

What is contraindicated in OMST and why

A

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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