consults

Question 1

Hypertension

Answer 1

BP is *** could be elevated, stable, uncontrolled, etc.

Continue (list BP meds if known)

Common BP meds: metoprolol, coreg, losartan, lisinopril, hydralazine, imdur, isordil, amlodipine. Memorize the spellings.

Question 2

Hyperlipidemia

Answer 2

Lipid panel (date of most recent lipid panel): Values LDL (most important), Triglycerides if very high, and Total cholesterol
On (list cholesterol medications if known)
Common statins: atorvastatin, rosuvastatin, pravastatin
Check to see if they are on Ezetimibe (Zetia)

Question 3

Diabetes mellitus

Answer 3

Most recent A1C result
As per primary service
Might be on SGLT2i such as jardiance

Question 4

Atrial fibrillation/flutter

Answer 4

(Add in if it’s Paroxysmal, Persistent or Permanent)
Ekg reviewed
.CHADS for
Continue anticoagulation (such as **eliquis, plavix, warfarin) for stroke prophylaxis **
Continue rate control meds: digoxin, beta blockers, diltiazem
Continue Antiarrhythmic meds: amiodarone, flecainide
Monitor on telemetry
Other things to note: is EP following or have they evaluated in the past? Has the patient ever had a cardioversion, ablation, etc

Question 5

Pre-op risk stratification for *** (they may mention cardiac clearance for surgery and this is what they are talking about)

Answer 5

Dr. Silverman uses .pspreop
.rrpreop is a good general one
EKG reviewed
Echo result if available
Stress test result if available
Cardiac cath result if available
Last line will include risk of MACE. (moderate, intermediate, high - the doctor will tell you or ask if they don’t)

Question 6

Heart failure (systolic or diastolic)

Answer 6

NTproBNP result
Recent echo result
Continue GDMT: ex: isordil, lisinopril, metoprolol, carvedilol, entresto, aldactone, jardiance, hydralazine (ACEi/ARB/ARNI/BB)
Common diuretics: lasix, torsemide, spironolactone
Check CXR

Question 7

Coronary Artery Disease

Answer 7

Include if there is any history of stenting (cath) or if they have had a CABG
Check for prior ischemic workup: Stress testing.
Troponin: for example “troponin peaked at…now down trending” “flat trend” “mild troponin elevation”
Common meds: aspirin, statin, antiplatelet: plavix, brilinta if they have any stents) If on aspirin and antiplatelet it’s called DAPT.

Question 8

Aneurysm of aorta

Answer 8

Measurement of aneurysm (find on CT or echocardiogram)

Question 9

PAD/PVD

Answer 9

Lower ext venous dplx result
On aspirin, statin

Question 10

Anemia

Answer 10

Check CBC
Mgmt per primary

Question 11

Atypical Chest Pain

Answer 11

Troponin
EKG reviewed
Cardiac cath result if available
Stress Test if done
CXR
Continue: aspirin, beta blocker, statin (only add these meds if they are on them)

Question 12

Cardiomyopathy

Answer 12

(ischemic or non ischemic)

Question 13

Can be added with CHF (Cardiomyopathy)

Answer 13

Ischemic: due to arterial blockage which decreases oxygenation to an area of the heart = reduced EF
Nonischemic: not due to blockage
Include if patient has any kind of device (ICD)
Most recent echocardiogram result

Question 14

CKD (Include Stage)

Answer 14

Creatinine level
Avoid nephrotoxic agents

Question 15

ECHOS

Answer 15

Transthoracic Echocardiogram (TTE)
Ultrasound of the heart by chest wall
Looking at ejection fraction(EF=pumping function) (normal is >50%)
Looking at any possible regurgitation or stenosis in the valves

Question 16

TEE (transesophageal echo)

TEE (transesophageal echo)

-

Answer 16

Probe down throat
-Looks for any vegetations (infections) on valves or looks for thrombus
-done when we are asked to rule out endocarditis(infection on valve), when someone has a stroke to rule out hole in heart (PFO), or to get better images of the heart
-cardioversion can happen as well to convert from Afib to normal rhythm

Question 17

STRESS TEST

Answer 17

Lexiscan cardiolite stress test (Regadenoson)
-Regadenoson is just a type of medication given
-Looking for the risk of ischemia (ischemia=part of the heart not getting enough blood due to blockage, cardiac muscle cells get damaged as they are not well oxygenated)

Question 18

monitors

Answer 18

MCOT: mobile cardiac outpatient telemetry

24,48,72 hr holter monitors
-looking for arrhythmias

7,14,30 day event monitors
-looking for arrhythmias

Question 19

Left heart cath/RHC

Answer 19

LHC: looks at the arteries in the heart
stenting is performed if needed (PCI), precursor to see if bypass (CABG) is needed
most accurate test to tell whether or not there is blockage in the heart
RHC measures pulmonary artery pressures (pulmonary hypertension)

Question 20

Carotid US

Answer 20

-looking for carotid stenosis

Question 21

Lower ext venous dplx/ upper ex

Answer 21

-looking to rule out DVT (blood clot )

Question 22

CTA chest

Answer 22

–look at size of AAA (can also assess on echo)