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Cardiology Part 1 (Heart Failure (transplant medications (cardiac…

- - - - 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
    - - lymphoproliferative disorders and skin cancer
- - - - established ASCVD
        
        LDL > 190
        
        Diabetes 40-75 with LDL between 70 and 189
        
        10 year ASCVD of 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
  - - - less than 120
    - - 140/90
- - - - what are you looking for
        
        symptoms, 1 mm horizontal
    - - 85% age predicted max HR, MET's 10, rate pressure product
        (HR x systolic BP) = 25,000
    - - BB (48 hours), nondihydropyridine, nitrates
    - - another testing
  - - - Dobutamine (increase oxygen demand)
        adenosine (vasodilators vs. maximally dilated vessels)
- - - - : chest pain, pressure, or discomfort that develops with exertion and is relieved with rest.
      - only 2
        
        atypical
      - 0-1
        
        non-cardiac
    - - 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
    - - 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.
    - - 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.
  - - - 120 minutes, otherwise give thrombolytics, still transfer
    - - 12-24 hours
    - - 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.
    - - left main, multivessel with PD, Diabetes, low SF
    - - ventriculography is classically defined by the presence of mid-wall and apical wall motion abnormalities with sparing of the basal segments, coronaries are normal.
      - characteristic wall motion
        
        wall motion abnormalities that extend beyond a single coronary territory,
  - - - 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