chronic CV pt 1

Question 1

exam findings for hyperlipidemia

Answer 1

skin lesions - eruptive or tendinous xanthomas

lipema retinalis
lipemic blood sample

Question 2

dyslipidemia screening

Answer 2

all adults >20 years every 5 years

earlier and more often if familial hx

middle-older adults q1-2 years

Question 3

when to start statin

Answer 3

LDL>100 + CV risk

maybe lower (LDL 55-70) for higher risk

low risk - >130 after lifestyle modification

Question 4

women risk factor for CAD

Answer 4

PO contraception - d/c with dyslipidemia

Question 5

statins AEs

Answer 5

myopathy/myosis, elevated LFTs, N/V/D, abd pain, HA, insomnia, rhabdo, hyperglycemia

Question 6

statin monitoring

Answer 6

baseline LFTs

lipid panel at 6 week intervals

drug interactions

LFTs, CK if myalgias
consider decreasing dose when 2 consecutive LDL<40

Question 7

statin contraindications

Answer 7

absolute - pregnancy, liver disease

relative - meds (cyclosporins, macrolides, antifungals, CYP 450 inhibitors)

Question 8

ezetemibe indication, monitoring, CI

Answer 8

LDL reduction in statin-intolerant individuals or combo therapy

baseline LFTs

CI in hepatic impairment

Question 9

bile acid sequesterants considerations & AE & CI

Answer 9

drug/drug interactions, vitamin malabsorption

may increase triglycerides, CI in TG>300

CONSTIPATION, dyspepsia, bloating, cramping, abd distention –>decrease adherence

CI in TG>300

Question 10

hypertriglyceride treatment

Answer 10

TG>300

fibrates
niacin

Question 11

fibrates AE, considerations, & CI

Answer 11

GI - abd bloating, N/V/D, gallstones

drug interactions ,monitor LFTs, monitor renal function

CI in renal & hepatic disease

Question 12

niacin AE & monitoring & CI

Answer 12

flushing with itching

take ASA 30 mins before, take at night

monitor LFTs

CI - liver disease, severe gout

Question 13

PCSK9 inhibitors

Answer 13

combo therapy w statin to lower LDL in those w family history

SQ injection

Question 14

omega 3 fatty acid - icosapent ethyl

Answer 14

for marked hypertriglyceridemia

can increase LDL & prolong bleeding

serious risk in pregnancy

Question 15

fadsfadfa

Answer 15

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Question 16

CHD/CAD exam findings

Answer 16

S4
S3 - ventric dysfunction
obesity
leg edema
pulmonary congestion
diagonal ear crease
hair patterns

Question 17

lab findings for CHD/CAD

Answer 17

ACS - troponin
lipid panel
elevated ESR/CRP
elevated homocystine

Question 18

CHD/CAD diagnostics

Answer 18

coronary angiography - diagnostic

myocardial stress test - initially performed

EKG - normal

Question 19

CHD/CAD managment

Answer 19

decrease risk!!!!

secondary - for secondary CAD with intermittent CP

antiplatelets, beta blockers - after MI or ACS, ACE/ARB

PCI revascularization

Question 20

cardiomyopathy

Answer 20

cardiac muscle dysfunction that results in systolic or diastolic dysfunction that is not due to atherosclerosis, HTN, or valvular disease

Question 21

dilated cardiomyopathy

Answer 21

-ventricular enlargement
-contractile dysfunction
-normal LV wall thickness
- systolic and diastolic dysfunction

most idiopathic

Question 22

dilated cardiomyopathy s/s

Answer 22

s/s of gradual heart failure

Question 23

heart failure exam findings

Answer 23

tachypnea
tachycardia
HTN
hypoxia
JVD
pulm edema
S3
murmur
hepatomegaly
peripheral edema

Question 24

heart failure symptoms

Answer 24

fatigue
DOE
dyspnea
orthopnea
PND
increasing edema, weight gain, increasing abdominal girth

Question 25

dilated cardiomyopathy diagnostics

Answer 25

labs - anemia, hyponatremia, low bicarb, TSH, biomarkers, BNP

EKG -baseline
CXR - cardiomegaly, pulm congestion

ECHO - LV dilation

cardiac cath

Question 26

dilated cardiomyopathy mgmt

Answer 26

same as for CHF

treat underlying conditions/RF

Na & water restriction

meds - decrease BP, antiarrhythmics, anticoagulation

pacer, AICD, LVAD, transplant

Question 27

meds for dilated cardiomyopathy

Answer 27

ACE/ARB
diuretics - loop
avoid CCB
antiarrhythmics - dig
hydral - decrease preload
anticoagulation for A fib

Question 28

hypertrophic cardiomyopathy

Answer 28

increased LV thickness
stiff LV restricts ventricular filling
diastolic HF

Question 29

hypertrophic cardiomyopathy cause

Answer 29

genetic

Question 30

top symptoms for hypertrophic cardiomyopathy

Answer 30

dyspnea!

pre-syncope
syncope
angina

sudden cardiac death if severe

Question 31

dilated cardiomyopathy exam findings

Answer 31

double/triple apical pulse
s4
murmur - positional
bisferiens carotid pulse

Question 32

hypertrophic cardiomyopathy diagnosis

Answer 32

TTE

Question 33

restrictive cardiomyopathy mgmt

Answer 33

no specific tx
treat underlying cause & symptoms

Question 34

hypertrophic cardiomyopathy diagnosis

Answer 34

TTE

Question 34

restrictive cardiomyopathy

Answer 34

impaired diastolic filling
reasonably preserved contractility
diastolic HF

amyloidosis/sarcoidosis #1 cause

Question 34

restrictive cardiomyopathy symptoms

Answer 34

gradually worsening SOB
progressive exercise intolerance
fatigue
weakness

Question 34

hypertrophic cardiomyopathy mgmt

Answer 34

cards referral, pregnancy/genetic counseling

goal to decrease cardiac contractility! no more exercising

BETABLOCKERS (metop), calcium channel blockers

ICD/pacer -RV, transplant, ablation, myomectomy

Question 35

restrictive cardiomyopathy differential

Answer 35

constrictive pericarditis

check BNP

Question 35

restrictive cardiomyopathy exam findings

Answer 35

RH failure
JVD
ascites
hepatomegaly
murmurs
decreased pulse volume

Question 36

healthy total cholesterol

Answer 36

<200