Week 5 CVS Flashcards
In patients without CVD, lipid testing is suggested in men age ______ and women age _______.
men 40 and up
women 50 and up
Testing can be considered earlier for patients with known traditional CVD risk factors including but not limited to hypertension, family history of premature CVD, chronic kidney disease, diabetes, and smoking.
When reassessing CVD risk in patients not taking lipid-lowering therapy, how often is it suggested to reassess lipid levels?
no more than every 5 years and preferably 10 years, unless risk factors change.
High-intensity statins are recommended when your 10 yr CVD risk score is _____ or higher.
20%
Moderate-intensity statins are recommended when your 10 yr CVD risk score is _____.
10-19%
What are the recommendations when your 10 yr CVD risk score is less than 10%?
Retest lipids in 5 -10 yrs (10 is preferred).
If your patient is on max statin therapy and still needs some help to decrease CVD risk, which meds are recommended?
Ezetimibe or PCSK9 inhibitors.
At what age is it recommended that we stop testing our patients’ lipid levels and assessing risk using a CVD risk calculator?
75 years old.
Statins are not recommended for primary prevention in patients 75+ yrs old.
True or false?
True, but it is still reasonable to so discuss risks vs benefits if your patient’s overall health status is good.
If your patient has a cardiovascular event but is older the age of 75, you should not recommend starting a statin.
True or false?
False. The CFP guideline recommends encouraging your patient to start statin therapy after reviewing risks and benefits.
If your patient is on a statin and tolerating it well, it should not be stopped simply because your patient reaches the age of 75.
True or false?
True.
What should you recommend if your patient cannot tolerate a statin due to non-severe muscle cramps?
Statin therapy > non-statin therapy. Try switching med, lower dose, or alternate daily dosing.
For primary prevention in patients unable to tolerate any
statin use, should you recommend non-statin use?
What about in secondary prevention?
Not in primary prevention.
In secondary prevention, it is suggested in the CFP guideline to explore non-statin meds like ezitimibe, fibrates or PCSK9 inhibitors
When should you repeat lipid testing once your patient starts lipid-lowering therapy?
The CFP guideline recommends against repeat testing, and against cholesterol targets.
What is the big red flag adverse reaction to statins to make sure you counsel your patients on?
Rhabdo! I heard my preceptor counsel about cola-coloured urine and I thought that was a good way to make sure they knew what to watch for.
Some patient teachings when you prescribe a statin?
May cause muscle cramping, low incidence of 5% or less.
Serious possible A/E: rhabdo, may increase your blood glucose and contribute to DMT2, and may cause memory loss or confusion.
Avoid grapefruit juice.
What is Afib and why is it a problem?
Atrial fibrillation (AF) is the irregular and rapid heart rhythm caused by abnormal electrical impulse formation and/or propagation. These impulses make the atria beat irregularly and in a dyssynchronous manner with the ventricles, causing blood pooling and poor systemic circulation
How do you classify Afib based on duration?
(paroxysmal vs persistent vs longstanding, permanent)
Paroxysmal = episodes last longer than 30 seconds but less than 7 days
Persistent = episodes last longer than 7 days but less than 1 year
Longstanding persistent = continuous AF for more than 1 year but rhythm control is still being pursued
Permanent = continuous AF where the decision is made to not pursue sinus rhythm restoration
What is the difference between valvular and non-valvular Afib?
Valvular = AF in the presence of a mechanical valve or moderate-severe mitral stenosis
Non-Valvular = AF in all patients who do not fit the valvular classification
Who most typically gets Afib?
Increased age (12% inover 75)
Male
Caucasian
What does Afib look like on an ECG?
irregular rhythm with no discernible, distinct P waves, lasting at least 30 seconds.
Why does a patient’s AFib become increasingly unlikely to restore (convert to sinus rhythm) the longer it goes on?
The presence of AF leads to structural and electrical re-modelling of the atria that over time, advances the severity from paroxysmal –> persistent –> permanent. Thus, the longer a patient has been in continuous AF, the less likely it is to terminate spontaneously, and harder it is to restore and maintain sinus rhythm.
S&S of AF?
- Palpitations
- Irregular, tachycardic, pounding/fluttering heartbeat
- Fatigue
- Weakness
- Dizziness/Light-headedness
- Dyspnea at rest or on exertion
- Potential angina
- Potential syncope
How do we diagnose Afib?
ECG (Sensitivity > 92% and Specificity > 90%) is the gold standard
Holter monitor
Echocardiogram (
o Assess for structural concerns related to valvular AF such as mitral valve stenosis
What are the 3 main pillars of management plan for AF?
1) lifestyle - managing modifiable risk factors & comorbidities
2) anticoagulation for stroke/systemic embolism prevention
3) rate/rhythm control