Cardiology Part 1

Risk factors

Cholesterol

highest for them

who get's treated

  1. established ASCVD
  2. LDL > 190
  3. Diabetes 40-75 with LDL between 70 and 189
  4. 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

  1. can do Coronary Calcium Score (>300)
  2. High sensitivity CRP > 2
  3. ABI below 0.90
  4. LDL 160 or higher
  5. 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