5: CAD Tx & Infectious (Quiz W6) Flashcards
1
Q
Optimize blood viscosity
A
nattokinase
proteolytic enzymes
gingko
2
Q
Decrease platelet aggregation
A
fish oil gingko garlic nattokinase aspirin plavix (clopidogrel)
3
Q
Chelation therapy MOA
A
EDTA chelates Pb and other metals, REMOVES Ca from walls of blood vessels, improves circ
4
Q
Chelation therapy IND
A
CAD, arteriosclerosis, arrhythmias, chronic lung dz, OA
5
Q
Chelation therapy CI
A
renal failure, acute kidney infxn, TB, unstable CHF, thrombocytopenia
6
Q
Chelation therapy labs
before initiating therapy
A
CMP (BUN and creatinine)
7
Q
Cayenne pepper
A
MOA: lowers BP, improves circ, aids in chelating arterial plaque, reduces cholesterol absoprtion
8
Q
Magnesium
A
“ND calcium channel blocker”, vasodilator
Mag glycinate is best
9
Q
Arginine MOA
A
releases into NO, given with gamma tocopherol to reduce nitric oxide free radicals
10
Q
Arginine IND
A
HTN, CAD, erectile dysfxn
11
Q
Arginine CI
A
herpes, chronic viral illness, COPD (pro-inflamm to lung epithelium)
12
Q
Hawthorne MOA
A
high in OPCs, strenghtens cardiac output, vasodilator, mild ACE-i action
13
Q
Hawthorne IND
A
high cholesterol, CHF, CAD, post MI, HTN
14
Q
Hawthorne CI
A
high output states (e.g. hyperthyroid)
15
Q
Grape Seed Extract MOA
A
vasodilator, platelet agg inhibitor, improves small vessel disease
16
Q
Decrease elevated lipids: Diet for ___
A
xxx
17
Q
Decrease elevated lipids: Diet for ___
A
ccc
18
Q
Nicotinic acid MOA
A
lowering total cholesterol/TGs and raising HDL levels
decreases LDL and LP(a)
increases large, buoyant LDL
19
Q
Nicotinic acid: reduces mortality in…
A
secondary prevention trials
20
Q
Niacin adverse effects
A
flushing, itching, GI complaints, weakness
LONG term AEs: hepatoxicity, hyperuricemia, glucose intolerance, ocular disturbance, ulcers, postural hypotension
21
Q
Niacin Labs to follow up
A
uric acid, liver enzymes, lipid fractionation
22
Q
Guggulipid IND
A
lowers total cholesterol/TGs, may increase HDL
decreases LDL
23
Q
Guggulipid MOA
A
enhanced excretion, inhibition of cholesterol syn, increased hepatic binding sites for LDL
24
Q
Red Yeast Rice
A
HMG CoA reductase inhibitor
can deplete CoQ10
25
Garlic
co-admin with fish oil--benefits lipids and lipoproteins
decrease total cholesterol, LDL-c
decrease TC:HDL and LDL:HDL
26
Phytosterols
decreases gut absorption of cholesterol
sunflower, flax, salba seed
(and to tx BPH)
27
Policosanol
modulates HMG CoA reductase
| positive effects on platelet function, BP, lipid peroxidaton
28
Fish oil
hypolipidemia, hypotensive, antithrombotic
| decrease total cholesterol, LDL, TGs, increase HDL
29
CoQ10 MOA
improves myocardial fxn
30
CoQ10 IND
CHF, hyperlipidemia, elevated Lp(a), angina/CAD, cardiomyopathy
31
pantethine IND
elevated TGs
32
Tx to decrease homocysteine
diet, B vitamins, SAM-e
33
Carnitine
improves myocardial O2 supply in angina, promotes remodeling of L ventricle, lowers TGs
IND: post MI, MVP, cardiomyopathy, CHF
34
Proline
MOA: lowers BP, aids in CT repair
35
Taurine MOA
reduces arrhythmias dt cardiac def, positive ionotrope
36
Taurine IND
CHF, CAD
37
Taurine CI
hyperdynamic L ventricle (pregnancy, hyperthyroid)
38
CABG limitations
25% rehospitalized in 3 mos of original surgery
high restenosis rate
complications- wound infxn, Afib, pleural effusion, thromboembolic event, cognitive decline
(CABG safer than stents)
39
Angioplasty with stent cautions
sequallae: post-stent thrombosis, foreign object rxns (worse with drug eluting stent)
pts need plavix 6mos-life
40
Angioplasty with stent morbidity/mortality changes
relieve chest pain
*Stents are used to improve quality of life, improve exercise tolerance, NOT increase life expectancy
41
Post Stent Meds
Plavix
Statins
ACE-i--reduce preload and afterload
Beta blockers--reduce rate, improves survival rate
42
Nitro
L sided MI ONLY (CI in R)
also give gamma tocopherol to quench nitric peroxide free radicals when on nitro, isosorbide mononitrate, smoked meat diet
43
ALL protocol
Aspirin
Lisinopril
Lovastatin
*given to pts with DM to reduce MI, stroke, costs, mortality
44
Natural alternatives to ALL
nattokinase, hydro, policosanol
| fish oil, hydration, niacin/sterols
45
BALL protocol
Beta blocker
Aspirin
Lisinopril
Lovastatin
CAD tx for early stage/non surgical pts
46
Acute Rheumatic Fever
sequalae from untx strep (less than 3%)
47
ARF PE and Labs
new murmur
**Anti DNase B Ab titer**strep test (IN in ACUTE infxn)
ASO titer
ESR
WBC
48
Modified Jones Criteria
MAJOR:
- migrating polyarthritis
- carditis, valvulitis
- CNS involv
- subQ nodules
- ertyhema marginatum
MINOR
- arthralgia
- fever
- elevated ESR/CRP
- prolonged PR interval
49
ARF Diagnosis
2 Major criteria + 1 minor
50
ARF Sequalae and prognosis
Chronic RHD
damage to heart valves
Prog: depends on initial infxn, reactivation leads to permanent heart damage
50% do not manifest cardiac involvement until yrs later
51
ARF Conventional TX
Abx for GAS: 10 days penicillin (or cephalosporin or macrolides)
TX asx household
aspirin for carditis and arthritis
TX the HF
pt remains on Abx prophylaxis
52
ARF Naturopathic TX
To tx GAS, but no research about treating RHD
53
Rheumatic Heart Dz
```
may not present for 10-20 yrs after initial illness
#1 cause acquired heart dz
```
54
RHD Pathophys
inflmmatory changes --thickening, fibrosis that derange the mitral and aortic valves
55
RHD PE
mitral stenosis
aortic regurg
aortic stenosis later
56
RHD Conventional Tx
```
NSAIDs
glucocorticoids
immunosupp
eridication of infxn
secondary prevention of reactivation
```
57
Endocarditis
infectious
- subacute
- acue
- prosthetic valve
non-infectious
- SLE
- CA
- DIC
58
Infectious endocarditis pathophys
initial activation- adherence of thrombus/microbe, then covered in platelets and fibrin
-s aureus, s viridans
59
Infectious endo RFs
congential heart defects, RHD, congenital bicuspid, calcified valces, MVP, cardiomyopathy, prosthetic valve
60
Subacute endocarditis
S viridans.
| insidious, slow progression, no indentifiable portal of entry
61
Acute endocarditis
S aureus.
| ACUTE, rapid, obvious portal
62
Infectious endo sxs
```
Fever
Roth spots
Osler Nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Embolic phenomena
```
63
Infectious endo DX: Modified Duke Criteria
path evidence (blood culture)
imaging/echo
clinical signs
Hx
64
Infectious endocarditis seq
HF= mortality (100% untx)
65
Infectious endo TX
IV Abx
| prophylaxis with RFs
66
Pericarditis pathophys
infection, trauma, post CABG, auto-immun, mets, drugs
67
Acute pericarditis etio
viral: 90% of infxs!
| - herpes, HIV, Coxsackie, Echovirus
68
Acute pericarditis sxs
severe substernal pain, radiates to back
WORSE inspiration, worse lying supine
better leaning forward
tachycardia, fever
69
Acute pericarditis PE
```
pericardia rub (HIGH specificity)
tachycardia
```
70
Acute pericarditis seq
pericardium can accommodate 120cc but > causes cardiac TAMPONADE
-hypotension*, JVD*, pulsus parodoxus, distant heart sounds*, narrowed pulse P
*Becks triad
Tx for tamponade: pericardiocentesis
71
Acute pericarditis Labs
```
ESR, CRP, WBC
EKG (ST Segment elevation, PR dep, low QRS)
CXR (cardiomeg, water bottle shape)
Echo
*CT with contrast
```
72
Acute pericarditis versus MI
MI: S4, local ST elevation
pericarditis: ST elevated in all leads, friction rub
73
Acute pericarditis TX
tx etiology, NSAIDs, maybe pericardiocentesis
74
Constrictive pericarditis
fibrotic thickening with adhesions and Ca depositions
etio: CT dz, radiation to chest
75
Constrictive pericarditis sxs
pericardial knock (diastole)
JVD, rising during inspiration- Kussmaul
ECG: low QRS
Afib in 1/3 cases
76
Constrictive pericarditis TX
rest, salt restriction, diurectics
| resection of pericardium
77
Aortic Stenosis Etiology
50% have CAD
```
#1. Calcified stenosis: unfused, stiff, obstruction variable and progressive
#2. Bicuspid aortic valve: one of the most common adult congenital heart disease, congenitally fused leaflets
#3. Rheumatic disease (from Rheumatic Fever): fused leaflets, obstruction fixed and progressive
```
78
Aortic stenosis versus sclerosis
Aortic sclerosis: valve leaflet thickening without obstruction to flow
Aortic stenosis: valve leaflet thickening WITH left ventricular outflow tract obstruction
79
AS sxs
```
angina
exertional dyspnea/lightheadedness
syncope
CHF
arrythmia
```
80
Aortic Stenosis sxs
murmur: systolic cresc-decresc, lean forwrad and radiates to clavicle
BEST HEARD in R sternal border, radiates to carotids
augment with squatting
parvus et targus pulse
81
Aortic Stenosis Labs
ECG: LVH, LV strain pattern with systolic overload (ST depression, T wave inversion ), LBBB
CXR: may show calcification in the valave
Trans thoracic echo: confirms dx
Significant AS:
Valve area < 0.7 cm
Valve gradient > 50 mm Hg
(Coronary angiography: for preop)
82
Aortic valve replacement
porcine-less likely to cause thrombosis and embolism
REQUIRED with ssxs, S4 sound, valve area < 0.7 cm, peak aortic gradient is > 50 mm Hg
83
Aortic Sclerosis
*most common cause of aortic stenosis
Atheroslcerotic degeneration of a congenitally normal valve
Less RISKy than other types of AS
PE: Can hear S1 and S2, early systolic murmur
(Vs. stenosis: can obscuring S1, longer duration)
84
Aortic Regurg RFs
rheumatic fever, infectious endocarditis, congenital bicuspid valve, syphilis, myxoma, idiopathic valve degeneration
85
Aortic Regurg Sxs
Fatigue and weakness, dyspnea on exertion, syncope, orthopnea,
Wide pulse pressure, low diastolic BP
Head bobbing "yes-yes" sign (dt wide pulse pressure)
Bounding arterial pulse in the neck
Bisfirens pulse
Subungual pulsations under their fingernails from large stroke volume
**Low diastolic BP + diastolic murmur in aortic region = aortic regurg until it is ruled out
86
Aortic Regurg Murmur
"to fro" murmur
early diastolic, high pitched, BLOWING
pt lean forward, hold breath
loudest in L 3/4 interspace
87
Aortic Regurg Imaging
ECHO to confirm and measure aortic root dilation
CXR: boot shape heart due to LV dilatation
ECG: LVH
88
Aortic Regurf Tx
avoid strenuous exercise
| Rule of 55 for replacement: EF <55% + LV dimension >55mm
89
Aortic Regurg Seq
Acute regurg CRISIS=
- due to dissection, trauma, endocarditis
- may cause pulmonary edema
- sxs: new onset AR murmur, sxs of LCHF
90
Myocarditis
commonly viral-
parvo B19, HHV-6
peds: Coxsackie, echovirus, adenovirus
seq: dilated cardiomyopathy
91
Takayasu Arteritis
vasculitis of aorta and branches
| F 80-90%
92
Takayasu Arteritis pathophys
immunologic with lymphocytes, macrophages, giant granulomatous inflammation in the media
SEQ: vessel dilation, aneurysm, stenotic occlusions
93
Takayasu Arteritis sxs
```
subclavian steal in arms
cool extremities
HTN
chest pain, MI, angina
aorta dilation, AR, HF
dyspnea, hemoptysis, pulmonary HTN
```
94
Takayasu Arteritis Diagnostic criteria
| 3/6
```
<40 yrs onset
claudication in legs,
systolic BP difference >10mmHb bet arms
subclavian, abdominal bruits
diminished brachial pulses
arteriographic narrowing of aorta
```
95
Takayasu Arteritis Conventional Tx
steroids
immunosuppressive
revasc of stenotic vessel
aortic valvuloplasty
96
Kawasaki Disease sxs
tachycardia, fever, hyperdymanic precordium
S3 gallop
angina
syncope
97
Kawasaki Dz Diagnostic Criteria
FUO 5+days plus 4/5:
- Conjunctivitis
- Cerv LAD
- Oral mucosal changes (strawberry tongue, etc)
- Non-vesicular, polymorphous rash
- Erythema/edema of palms/soles
98
Kawasaki Dz Labs
```
ESR, CRP, leukocytosis with L shift
reactive thrombocytosis
anemia
pyuria
CSF abnormalities
```
99
Kawasaki Dz Seq
ischemia, infaction, myocarditis, cardiomyopathy, HF
coronary a aneurysms, MR or AR
atherosclerosis
100
Kawasaki Dz Conventioanl Tx
IV IG
steroids
anticoagulants
