Cardiology Part 1
Risk factors
Cholesterol
highest for them
who get's treated
- established ASCVD
- LDL > 190
- Diabetes 40-75 with LDL between 70 and 189
- 10 year ASCVD of 7.5%
how to risk stratify
Frammingham score
Lp(a) lipoprotein/homocysteine
no evidence
intermediate risk ASCVD
5-7.5%
additional tests
- can do Coronary Calcium Score (>300)
- High sensitivity CRP > 2
- ABI below 0.90
- LDL 160 or higher
- premature family history 55 in first year male, 65 in female
BP
SPRINT
less than 120
JNC-8
140/90
Diagnostic Cardiac Stress Testing
who should this be employed for
intermediate risk
Exercise ECG
if patient can walk, and baseline EKG without a lot of abnormalities
Stress Echo
baseline ECG has LVH, LBB, paced rhythm, WPW)
what are you looking for
symptoms, 1 mm horizontal
adequate?
85% age predicted max HR, MET's 10, rate pressure product
(HR x systolic BP) = 25,000
pharmacological
Dobutamine (increase oxygen demand)
adenosine (vasodilators vs. maximally dilated vessels)
which medications should be withheld
BB (48 hours), nondihydropyridine, nitrates
if inadequate/indeterminate
another testing
Who gets TTE for murmors
3/6 systolic or any diastolic murmors
Coronary Artery Disease
Stable Angina
triad of classical angina
: chest pain, pressure, or discomfort that develops with exertion and is relieved with rest.
only 2
atypical
0-1
non-cardiac
treatment
morphine ,ASA, Nitrate (short and long acting), oxygen, BB (55-60), Statin
if not helped then add
long-acting nitrate titration/CCB
if not helped then add
ranolozine
dual platelet therapy after revascularizaition
In patients who undergo PCI, dual antiplatelet therapy (aspirin [81 mg/d] plus clopidogrel) is recommended for at least 1 month after bare metal stent (BMS) implantation and at least 6 months after drug-eluting stent (DES) implantation, although extended use may be considered on an individual basis if the patient does not have a high risk of bleeding and has tolerated dual antiplatelet therapy well ( Table 9 ). Dual antiplatelet therapy for 1 year may also be reasonable to improve vein graft patency in patients who undergo CABG.
STEMI
time to PCI
120 minutes, otherwise give thrombolytics, still transfer
onset of symptoms for PCI
12-24 hours
common rhythm after thrombolytics
accelerated idioventricular rhythm (AIVR); AIVR is considered a benign rhythm when it occurs within 24 hours of reperfusion. A repeat ECG should be obtained 60 minutes after thrombolysis to determine if ST-segment resolution has occurred.
Right ventricular infarction
triad of hypotension, clear lung examination, and elevated jugular venous pressure. Diagnosis is often made clinically and can be confirmed by either ECG (leads V4R through V6R)
treatment
reperfusion, aggressive volume resuscitation, and the use of inotropes (dopamine or dobutamine) until right ventricular function improves (often 2 to 3 days after myocardial infarction
CABG lesions
left main, multivessel with PD, Diabetes, low SF
ventriculography in Takayasu
ventriculography is classically defined by the presence of mid-wall and apical wall motion abnormalities with sparing of the basal segments, coronaries are normal.
stress testing in diabetes
stress testing is recommended by the American Heart Association for those who are (1) symptomatic, (2) initiating an exercise program, or (3) known to have coronary artery disease and have not had a recent (>2 years) stress test.
Heart Failure
name the BB with mortality benefit
metoprolol succinate 200 mg, carvedilol 25 mg BID, and bisoprolol 10 mg daily
digoxin toxic level
1 ng/ml
values you cannot use spiranolactone
Because of the risk of kidney dysfunction and hyperkalemia, these drugs should be used only in patients with a serum creatinine level below 2.5 mg/dL (221 µmol/L) in men or below 2.0 mg/dL (176.8 µmol/L) in women, and with a serum potassium level below 5.0 mEq/L (5.0 mmol/L).
indication for ICD therapy
indicated for patients with NYHA functional class II and III symptoms, ejection fraction less than or equal to 35% on guideline-directed medical therapy, and a life expectancy of at least 1 year
cardiac resynchronization therapy
strong supporting evidence for CRT therapy in patients with an ejection fraction less than or equal to 35%, NYHA functional class III to IV symptoms on guideline-directed medical therapy, and left bundle branch block with QRS duration greater than or equal to 150 msec
transplant medications
calcineurin inhibitor (cyclosporine or tacrolimus), an antiproliferative agent (mycophenolate mofetil, sirolimus, or everolimus), and prednisone
cardiac allograph vasculopathy
Cardiac allograft vasculopathy occurs in more than 50% of the patients by the fifth year after transplant. It is characterized by diffuse intimal thickening of the coronary arteries that starts distally and progresses proximally
malignancy
lymphoproliferative disorders and skin cancer
characteristic wall motion
wall motion abnormalities that extend beyond a single coronary territory,
common bugs for myocarditis
adenovirus, coxsackievirus, and enterovirus
icd after heart attack
40 days